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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER/ DEM ITION <br />CITY OF EVERETT PERMIT SERVICES <br />OL 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: 112A 6RA4Q Me <br />PROPERTY TAX #: 004oq47-7-5oozoo <br />LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ,� ,---LLV TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY IT- STATE ZIP <br />OWNER PHONE: Z <br />OWNER EMAIL: V1erba V/ V` , Cp <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: STREET 12-501 441^ t1r N E: <br />, , <br />CITY ±�)� J STATE �/V ZIP is <br />CONTRACTOR PHONE: 2,. © Z <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): * PH I L l & C-907J H <br />ICITY OF EVERETT BUSINESS LICENSE #(REQUIRED): t7 <br />PRIMARY CONTACT: KOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: lioucolE — Ees ku)6NM <br />Contract Price of Work: $ U00 <br />Proposed Use of Building: ftu I: , <br />Heat Source: IO1Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached FIR -Attached []Duplex []Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: []New ❑Addition Remodel ❑Repair ❑T.I. []Sign []Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />I. LOu4TF- <br />ASSOCIATED BUILDING PERMIT # (if applicable): l (Q Z 3 3 1= 17 0 % -- 04 <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration _Repair <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />I <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />L <br />Other: IL lk fin. <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or water I <br />I No. of Heads <br />A&NOWLEDGEMENT: l 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 l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Omcial Use Only <br />FF(U2-CIS 3 <br />.rsa.►r� <br />%T <br />