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OLTPERMIT APPLICATIC <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 I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE.INFORMATION <br /> PROJECT SITE ADDRESS: .)"\nW \\}VZkM�+ V(. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ` CONTACT INFORMATION,. , <br /> OWNER NAME: 30kAso--‘ AWLc ` TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET IVoT ` <br /> ((CITY STATE \QAT ZIP lib OOP' <br /> OWNER PHONE: 5i5) —140-D OWNER EMAIL: ��A o' �...... U,- �y. ••�,. knou,C,S• CO--v <br /> t <br /> CONTRACTOR NAME: Q(.)\ye \")),1/41--,L <br /> CONTRACTOR ADDRESS: JJ STREET v(92" 5G__ S 1/2- ` ,/� ,( <br /> CITY ��j 1k1/4A 4.. `STATE \j/k-- ZIP 16c/05CONTRACTOR PHONE: �,I""��.,`� tjej(o- 0 CONTRACTOR EMAIL: en\c,.,..,,?/nf, <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE (REQUIRED): <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: A\04,\ (R0‘0; CONTACT PHONE:0 5) 5,36---44-00 <br /> CONTACT EMAIL. c,\ <br /> Qs."-',.? , t�� <br /> BUILDING;PERMIT;APPLICATION- <br /> Existing <br /> APPLICATIONExisting Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 #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 /> 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 /> SPRINKLE'/.SUPPRESSION SYSTEM,' <br /> Number 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 /> PERMIT# <br /> 1IV0I1 h701'b0`7 <br /> Owner orized Agent Signature Date (Revised 5/20/2016) <br />