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PERMIT APPLiCAS'➢OH � <br />ICU➢LD➢NG / ➢ ECHANICALL / PLUMBING / SIGN / SPREI 9K ER / DfEM ➢ ION <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 link Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: m <br />PROPERTY TAX #: C04WU-5oozoo <br />LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) t ®vi'59 �6 via" <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (if Commercial): <br />OWNER MAILING ADDRESS: STREET & T) I a- <br />.. CITYt�JeEVTSTATEzip 91SWI <br />OWNER PHONE: 42.15,'Z�l2o ZA <br />OWNER EMAIL: , gf:tlyierba uk CO <br />CONTRACTOR NAME: j7H ( L L-( f7e, Codes c - <br />CONTRACTORADDRESS: STREET 12,501 44tt` 9 <br />CITY �. ` � STATE W ZIP 112-5 <br />CONTRACTOR PHONE: 1® l, t <br />CONTRACTOR EMAIL: 1 �0r y- 4 <br />CONTRACTOR LICENSE #(REQUIRED): H I U Co 07J H <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRE . o5 <br />PRIMARY CONTACT: <OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: t)L)S a l tiC.V— <br />Contract Price of Work: $ 4olvoo <br />Proposed Use of Building: AAOUSE- <br />Heat Source: DUGaS []Electric ❑Other <br />Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi -Family- # of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New OAddition IZRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: pP f�� g p►� <br />S 'Sue' <br />ASSOCIATED BUILDING PERMIT # (if applicable): <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 />.1 <br />Kitchen Sink & Disposal <br />Grease Trap <br />I <br />Gas Range <br />DuctiJHeads <br />➢ <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />OtherClothes <br />Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: u& W e3 <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER I SUPPRESSION <br />SYS` <br />Chemical or Water <br />No. o <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 l 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 />LF„-inn c - <br />(Reviscu 3 16) <br />M <br />