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PERMIT APPLICATIO• <br /> '11111 .‘ BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 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: ($0 1 1114 ST, !✓vE-pr 882.01 PROPERTY TAX#: Otr`Y7$2118oicoo <br /> LEGAL for new construction: Short Plat/subdivision N ILK 393 D 00 Lot No.IS/ib(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TONY S IMOWE(,L-I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Et01 (1 th 'Si <br /> t <br /> CITY G V{te r STATE WA- ZIP 140A <br /> OWNER PHONE: tor—111_0119 OWNER EMAIL: 1i (c tt towt-u1 Q '(OTIM jL.coNNI <br /> CONTRACTOR NAME: OW N . <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: *OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 0 vV 1JE9. CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RES(De NLE —?Rl MAR' Contract Price of Work:$ Si 000 <br /> Proposed Use of Building: SkM.E Heat Source: lamas ❑Electric ❑Other <br /> Building Type: 'SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New IgAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: AD01T(o 0 OF coVl teO pog,c i. <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/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 u der 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 18.27 RCW and 296.200A WAC. <br /> ^ rate City of Everett Official Use Only <br /> ti 1 <br /> 7I LOI PERMIT Ie(go 7 c3 <br /> Owner uthor' ed Agent Signature (Revised 9/23/2016) <br /> Z <br />