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OILPERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECTSITEINFORMATION <br /> PROJECT SITE ADDRESS: 8f % Cjrl,/.% k- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No.1 attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f.'f/2,4J �p��H TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: h u4N►.854 C-4::)N<TILkic.T��a <br /> CONTRACTOR ADDRESS: STREET p n, <br /> CITY h STATE Li ". ZIP 9 012 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ..H U4 IAGIa5t f ' CITY OF EVERETT BUSINESS LICENSE#(REQUI D): sq l C] <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:,G p <br /> CONTACT PHONE: f (o � <br /> E fie 1 'k)‹.�R V Gj CONTACT EMAIL: „J c„."F7' 7 ti1/4)4tlE.66=144c•IN,tssvh <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ^r ,l l- Contract Price of Work:$ I 60'1404:=4=' <br /> Proposed Use of Building: ' >'i'/o.& Heat Source: 149as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition XRemodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: T. 10 ofesti 1 4$ 'F'Ia So D-rt1 W#tJA..> 44.1,0 YJer►%SIIJyl <br /> • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #ofList of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> ForcedAirSystems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER <br /> /V-1— 14R I <br /> caner/Authorized A ent Signat e Date (Revised 9/23/2016) <br /> 9 9 <br />