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PERMIT APPLICATION <br /> IIII BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> vi CITY OF EVERETT PERMIT SERVICES <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: 27't 2-- n m e, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: q yn(\A C\eAry•N LJGATENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ` 2_ \ " t1 ._ S4 • <br /> IQ1 .--51e-- CITY 6 STATE /� )),�,ZIP U� 0 f <br /> OWNER PHONE: yS 1, 2:7 OWNER EMAIL: ( n ) 6 L ( 3 '' `w�oan r �,,,,,^ <br /> � 8 � <br /> CONTRACTOR NAME: (y (e. o."--- . (—,,•,r, \ ' <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: (-AI-S �t (( gU'L� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:kOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (j S gvl 6 g Li 2`7 <br /> GtA^(Y4 64 P k r\cOi )AA9 G 9 CONTACT EMAIL: \Y1 o\\ ("1 it C yv‘Otn\^ (A <br /> BUILDING PERMIT APPLICATION �y <br /> Existing Use of Building: Contract PIice of Work:$ pal <br /> Proposed Use of Building: Heat Source: OGas DElectric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> a r� ,vte�G -�c4-Q- /-‘ <br /> x-7)c - fie or coo-7(e <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 ist of Fixtures #of res #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> = ; (Heat Pum Toilet Backflow Preventer(Inside Bldg) <br /> o .i"r'. •Ir ys - - eater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Watt' -: Refrigeration Shower Floor Drain <br /> _.s Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas -. •e 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 1 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.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 /> City of Everett Official Use Only <br /> 2i� PEfren IQ/I/r5ro e,1u0 Z--DD <br /> -3 <br /> ner/ hohod gent Signature ate (Revised 9/23/2016) <br />