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PERMIT 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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov( www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 100 Li bkr,t/A_ ro,fL.. DV- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 4 e, ✓� �l �� o� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 0 U PJv i', . Dv- <br /> CITY <br /> ✓CITY N. t/ - ( W2�-3 STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: 04.4.4.v6-e (i„U <br /> CONTRACTOR NAME: eG'.„„, ,,e <br /> CONTRACTOR ADDRESS: STREET °l 51(„2 ( tE• <br /> CITY STATE Ut.) ZIP <br /> CONTRACTOR PHONE: 4"i- - 5 (- 'l'(p(l CONTRACTOR EMAIL: <br /> C1a-NrrR et_ c� t� <br /> CONTRACTOR LICENSE#(REQUIRED): iJ 1(a.( 6,0(3L431 of -1 u-& CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): - t <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4-2_s— <br /> C--t2 <br /> ,( -- <br /> l v` Civ CONTACT EMAIL: .te (A, - U� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: fp- Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family4 of Units: DCommercial CI Industrial <br /> Type of Project: ❑New DAddition CI Remodel DRepair DTI. ❑Sign ❑Sprinkler CI Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: r � Orr t ee, <br /> �- 1gjbZ��rlb <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 /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems 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/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 /> 2 PERMIt o / <br /> Owner/Authorized Agent Signature Date • (Revised 9/23/2016) <br />