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4 PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i2 ��„ 018ZO; PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) • <br /> CONTACT INFORMATION <br /> OWNER NAME: (FA/Z /L, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (.0S1)2_,�_ C(y y�n(9A� <br /> CITY /fit F STATE IJ/ ZIP °A� _ <br /> OWNER PHONE: (C/00_ 63n--161;2--V_', OWNER EMAIL: TO i y--t T @.../\01-VVIC1 f Q"`���VVVC,i�'VL <br /> CONTRACTOR NAME: """� <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: QWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: .r y� ron, LAL,Cin CONTACT PHONE: _� �(Q <br /> �►!/(� CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: .(itka>1(._ Contract Price of Work:$ <br /> Proposed Use of Building: QqA, Q Heat Source: ❑Gas NKectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 26uplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: El New ❑Addition CI Remodel ®Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> rcrrr, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATI9N PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: _New _Addn Alteration 'Repair <br /> #of List of Fixtures # f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures xtures Fixtures Fixtures <br /> A/C-Air Handling Unit Heat Pump Toi-t Backflow Preventer(Inside Bldg) <br /> Forc- Air Systems Unit Heater 7 Bat ub Urinal <br /> Gas Pi,'ing Boiler Levet. (Wash Basin) Drinking Fountain <br /> Water H_-ter Refrigeration S er Floor Drain <br /> Gas Firep - Wood Stove °Z Itchen Si &Disposal Grease Trap <br /> Gas Ran.- Ducting Dishwasher Roof Drains <br /> Clothe Dryer ,okups Other: Clothes Washer Medical Gas <br /> Ran•- Hood - Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 /> PERr� <br /> / \ Oi -k C.1"-l ra7-\ J ( <br /> Owner/Au ized• Agent Signatu Date (Revised 9/23/2016) <br /> 1 ., <br />