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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> ' w/#1.11) —A 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 /> '�q 1 <br /> PROJECT SITE ADDRESS: V I ' / 0 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ?..--S21( <br /> CITY STATE tAA /n <br /> ZIP eZC) <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: r � <br /> , � <br /> CONTRACTOR ADDRESS: STREET t1O '_ / / , , -6 <br /> CITY %/Irte/ �-/-�/ STATE 6/1)\/14.-/y ZIP �,, ",) <br /> CONTRACTOR PHONE: 47,..,c-771,/' lSI S i'-'t G£' CONTRACTOR EMAIL:? / €'S (' l f Jlif "'e�/GI,r- <br /> CONTRACTOR LICENSE#(REQUIRED): 6 / CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):✓ c -R 7 <br /> PRIMARY CONTACT: 0 OWNER .EOIITRACTOR 0 OTHER(Please Specify), <br /> CONTACT NAME: VV CONTACT PHONE: `'C 77/../ c7(---7l Cc <br /> 1-)1 ''U I/(7) - CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$/C) lLL,"— <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 DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF�WORK: Q �/ <br /> f�V W(tNWC/ C'„- <br /> e bTh/k----Z___, <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 I SUPPRESSION SYSTEM <br /> Chemical or Water I 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 /> r <br /> City of Everett Official Use Only <br /> tr PERMIT#� t (�' o Co..„ OOI <br /> `'LD (/ V ` o (J 1 <br /> Own-r/- • ized ,ge ;ignature Date (Revised 9/23/2016) <br /> y_,_i <br />