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PERMIT APPLICATION <br /> BUILDING I 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 <br /> �• SITE INFORMATION <br /> PROJECT SITE ADDRESS:S?/ 7 Loc�C r I R BY C_ 41- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:T-il-T iZ\CAC_ \'' lkiV t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREETS$ t`Z Lp c.-- Qt (, RI) <br /> CITY -GA(east_14- STATE 14 A, ZIP 1 TZ_V 3 <br /> OWNER PHONE: 4 ZS Z-3i 9.('I OWNER EMAIL^ V tt elPgme.,1C 1 4 Gy✓ 44 I <br /> CONTRACTOR NAME: DCi N r��� , <br /> CONTRACTOR ADDRESS: STREET 1�+ <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: (A5 D <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 DTA. ❑Sign DSp ' kler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Aad) ✓1 c T SaU f of ?ecf_yr ri M 1 -Fcv3—ds'v i Z ex c-OS A, caeANQ <br /> I RanoL Hoo 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 _Repair <br /> #of List of Fixtures #°f List of Fixtures #°{ 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 Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range HoodWater Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/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 - d 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 b,ore;eing 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 w the •a 4 Contract. ♦ 18.27 RCW and 296.200A WAC. <br /> City of Everett 3Official Use Only <br /> `� /� PERI 0 <br /> Owner •uthorized Agent Signature Date (Revised 9/23/2016) <br />