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PERMIT APPLICATIOi'�= <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER DEM ITION <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 />(Blare or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: 2- 6 ® Me <br />PROPERTY TAX #: 004 2.Z clo o <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �iTif— �Z„ (,� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY STATE ZIP <br />OWNER PHONE: �2 , 211 Zg <br />1' <br />OWNER EMAIL: Vterba " CA > CO <br />CONTRACTOR NAME:H�j- <br />CONTRACTOR ADDRESS: STREET 2 C7 h" t1r %I g <br />j ' t <br />CITY L-kLe �mveN $ STATE A) A= ZIP I fs 2-5 <br />CONTRACTOR PHONE: 2_5 ® 'L <br />EMAIL: *WrK � <br />,ry-CyONTRACTOR <br />CONTRACTOR LICENSE #(REQUIRED): * f H LI CX C Y� ! H <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRE Q <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: R`i ID6N ✓ <br />Contract Price of Work: $ Jol000 <br />Proposed Use of Building: +k00 E <br />Heat Source: DUGas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached FR-Attached []Duplex []Multi -Family- # of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition loRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />' Lpc>arT� YLtTCG f A . <br />Uis <br />ASSOCIATED BUILDING PERMIT # (if applicable): 13 1(a I [— — o -3 3 <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 />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 />Other: E P_ (y A r--1L <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />SPRINKLER / SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />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 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 />(Revised 9 N2016) <br />IMA <br />