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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 I FAX 425-257-8857 I(E)everetteps©everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: <(027 RGek,els 44y42 PROPERTY TAX#: <br /> LEGAL for new construction: Short Pia subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: S-fee1 clr,S <br /> CONTRACTOR ADDRESS: sTREEf /91/1h J-h7, r A <br /> CITYi ,,r,y, STATE ZIP 9�3t� <br /> 425-CONTRACTOR PHONE: -g3'- 2_ CONTRACTOR EMAIL: y),r/ke Q c 6e 5 5 <br /> CONTRACTOR LICENSE#(REQUIRED): r.c S 4 q&c-P CITY OF EVERETT BUSINESS CENS #(REQU ):fy�;�, t <br /> PRIMARY CONTACT: 0 OWNER C�CTOR 0 OTHER(Please Specify) ,...) <br /> CONTACT NAME: CONTACT PHONE: 4 2-5- -,-7?-- ®O) 2 a-Ullfri <br /> 3,4riles' Fayk_ CONTACT EMAIL: jTh4 eS ,P /. , c r/I <br /> BUILDING PERMIT APPLICATION �� <br /> Existing Use of Building: Contract Price of Wo $ l7 <br /> Proposed Use of Building: Heat Source: ❑Ga- ❑Electri ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-F ily-#of Units: ®Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> TTS- -all CillO tej L.-ell ' a'YN Yart7 <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 /> SPRINKLER I 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.lam the owner,or!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 /> p (' City of Everett Official Use <br /> Onlyly <br /> if A I C / �" PER t"1 \2 " o 5 <br /> Owner/AuthorizA,e t Ignature Da (Revised 9/23/2016) I <br />