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/ }PAL � PERMIT APPLICATIOf- <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 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: _71/ S-F1ax0IP `q N t QaPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision " "1 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION / <br /> OWNER NAME: MA N U V lR 5 <br /> R QM SA CA TENANT NAME(If Commercial): 1 d'r` , <br /> OWNER MAILING ADDRESS: STREET oI..Di NI AODISC�N et• <br /> ciTy t v MR, i ` ^_ STATE w IN ,i y ZIP 6Wia0a <br /> OWNER PHONE: 61 0— 0 IU OWNER EMAIL: MV <br /> ��l:IGq____.f...._��jl�,h <br /> �lorn <br /> CONTRACTOR NAME:��J bJ 2 `S y ^F-- �-— L_€ir2_._ <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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION ' .�ir.I 9(''� <br /> Existing Use of Building: Contract Price of Work:$ ,A Y <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other' <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 00-e—tiO S fn <br /> 61 <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 jepair <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 .-. er Bathtub Urinal <br /> Gas Piping :oiler Lavatory(Wash _n) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen t k&Disposal Grease Trap <br /> Gas Range Ducting Dis r.,asher Roof Drains _ <br /> Clothes Dryer- •okups Other: •othes Washer Medical Gas <br /> Range Hoe• Water Heater Other: <br /> Exhau Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I INo.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 /> rt <br /> pCity of Everett yOfficial Use Only <br /> (9,--;---D-71-- , <br /> 007 -4 <br /> Ow th ed Agent Signature Date l (Revised5 <br /> 9/23/2016) <br /> g <br />