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,msPERMIT APPLICATION <br /> �Ts BUILDING /MECHANICAL/PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> 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: S 7-2, �q /ry LI g I//ev PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ?4ve_/ Do l / (,tire TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET) 7- �G,,.fr--`cvi-R/ Z-17 <br /> CITY ' /Cf.`"e 1/// STATE hi v ZIP ,982.02525 <br /> Y <br /> OWNER PHONE: 1405 aV-& 7OWNER EMAIL: pcwjc.4yACONTRACTOR NAME: 0I /1 V �J �/ <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: 424 22z, Lia <br /> Pet.,LA,f lG Q f`I CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Wor $ 0� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ornr -cial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ISIGkJ <br /> j2 . <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 Fixtu - #of List of Fixtures #of List of F,.•,res <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat P p Toilet Backflow P -'enter(Inside Bldg) <br /> Forced Air Systems U. eater Bathtub Urinal <br /> Gas Piping :oiler Lavatory(Wash Basin) Dr- Ing Fountain <br /> Water Heater Refrigeration Shower loor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hook Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Servic--;al./Mop/etc.) Other: <br /> SPRINK R/SUPPRESSION SYSTEM <br /> Che cal or Water ' No. of Heads <br /> ACKNOWLEDGEMENT: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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> CityyooflEverett Official/Use <br /> eOOnly t <br /> ,d) PERT r `s t71 5, <br /> x J� ..°-V 1 <br /> Owner/Authorize Age t Signa Lire D to (Revised 9/23/2016)` <br />