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0477IT APPLICTION <br /> BUILDING / MECHANICALS/ PLUMBING I SIGN I CR <br /> INKLER/ 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 I www.everettwa.gov/permits <br /> (Slue or Black Ink Only/ Please) PROJECT SIT N NATION <br /> PROJECT SITE ADDRESS:t 3 20 YD Ll_o WA(I"- f,GYC D jii�i� PROPERTY TAX#:0 6 4 I-2...80o00 IS o <br /> LEGAL for new construction: Short Plat/subdivisionFWs„,Vto Lot No. (attach copy of long legal description) <br /> ti(, j e++ CONTACT INFORMATION <br /> OWNER NAME: l� (Ali/SO/i. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREErfn;Co/Q.,. Naso//, kw. (oyn) 132-0 NOUOtAl Ocx�•..2 e'aL.e- <br /> CITY gAik.e,re..„4- " STATE LAM- ZIP r y cite_ <br /> OWNER PHONE: Li "7 CoCY 02-6 1OWNER EMAIL:h i W <br /> o%Z, ;k So/? u' W K •C oma? <br /> i <br /> CONTRACTOR NAME: l 1L(32-- <br /> CONTRACTOR <br /> -- <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 <br /> Existing 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: ❑�-, NI A ddition ❑Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> • SCRIPT i 1 ORK: . <br /> -. 0 —,'' , 1 YI U\ Qt—k"\(sca 5 pvue,y_e_te ? C%02-CO <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 /> NC—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 /> �� %� ),.�� g`/ Pic o t �-- <br /> O errized Agent Signature Date/ (Revised 9/23/2016) <br />