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PERMIT APPLICATION <br /> BUILDING-ECHANICAL/ PLUMBING /SIGIRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVI <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I 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: 2_976 Sk j 1(62 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION �t <br /> OWNER NAME: k 41,-e /ori TENANT NAME(If Commercial): Si1U L(. C <br /> OWNER MAILING ADDRESS: STREET I a <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 'FW <br /> CONTRACTOR ADDRESS: STREET� 2i7/(, -m -j-, 4 /65� /c <br /> crre —�'1 STATE CjC\ ZIP � V 3 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) `�.e 1-"` <br /> CONTACT NAME: CONTACT PHONE: b --66S`3 <br /> nYl,/\ Kr.frCONTACT EMAIL: p; S+yteLt Oa,,.7 <br /> `BUILDING;PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ t DOO$°-� <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 pitRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinklers"❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> d6'l �05j`Z erode- c 5'Yc''n CoonadaS ficfretehOi ezekn, <br /> vag- <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 #of List of Fixtures List of Fixtures #of 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 I 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 /> 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> s./ /2-0/-6 PERMIT N /_)52,/ <br /> Owner/Authorized Agent Signat a Date (Revised 5/2 /2096) <br />