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PERMIT APPLICATIONi <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> *Fr 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: LJ, E-(..()I `a jo PROPERTY TAX#: b(4010C) , -(900 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 0 e v/) C7 !D �T-2 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET rj' L Pj E c__31 5T <br /> CITY �^ � �ti'!� STATE (L ZIP 9 2zs3 <br /> OWNER PHONE: J Zj- gQ - (p(g OWNER EMAIL: -0(,,_"P 0,046 , Co ,,e/k <br /> CONTRACTOR NAME: 0 W IX) R <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: 14 z 5`_7 5'4.3 4 <br /> J N () r1} CONTACT EMAIL: (i l V. S ` , <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 64/2?02 j Contract Price of Work:$ oon 6O <br /> Proposed Use of Building: G-qHeat Source: tat. ❑Electric ❑Other ONE- <br /> Building Type: ❑SFR-Detached INSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ,Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition Change of Use <br /> DESCRIPTION OF WORK: <br /> ( oivuF2-T Si►vnl,, C44r- CIA poa t Pc)1-e_Com. &A-RAG1 <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 'xtures #°f List of Fixtures #°f List• Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units H- •ump Toilet Backflow ' enter(Inside Bldg) <br /> Forced Air Systems m nit Heater Bathtub Urin- <br /> Gas Piping Boiler Lavatory(Wash Basin) P king 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 Hoo.ips Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Servic- :ar/Mop/etc.) Other: <br /> SPRIN ER/SUPPRESSION SYSTEM <br /> C mica)or Water I No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information .ntained 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 /> ./1 5-2(1-:ZOrg PP c 2 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/26) 7 ICJJ�,,yrs .0i�% <br /> .wy <br />