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PERMIT APPLICATIOIJ-- <br /> alLAIL 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only P <br /> le <br /> /a <br /> pse) PROJJECT SITE INFORMATION�h <br /> PROJECT SITE ADDRESS: /1/11/ Saw/fag E°i. WO9rad ROPERTY' TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:jj r Ct I" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Lwow-/ 58.'16- L)f`_ �� � V Q� <br /> CITY Y', <br /> tiefSTATEAr# ZIP <br /> OWNER PHONE: - O 4 ,'7-/q r OWNER EMAIL: (J( /L rV ggilir <br /> CONTRACTOR NAME: pra m �/� /�q . r <br /> CONTRACTOR ADDRESS: STREET / <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: Lf 45=3,2j 96 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): PEOro AS 94.54 ) CITY OF EVERETT BUSINESS LICENSE#(REQU D): Soc.. <br /> PRIMARY CONTACT: g OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> NTACT N ME: CONTACT PHONE: L, � /� 4-< / — <br /> C <br /> u014A, r Wine% CONTACT EMAIL: goir () ,/ - . - e fi i-- <br /> BUILDING PERMIT APPLICATIOII( <br /> Existing Use of Building: tin& Contract Price of Wor. $ 11 <br /> Proposed Use of Building: Heat Source: ❑Gas KElectri' ❑Other <br /> Building Type: ❑SFR-Detached f SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Now– <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ■Demolition I1Change of Use <br /> DESCRIPTION OF WORK: <br /> r� as [IN,- r bOrillilaYvyl x', <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 Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking 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 /> f Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water I No.of Heads <br /> ACKNOWLEDGEMENT:1 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!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 /> • <br /> ( 1ai' 'I� i1/ — gPER��IT# D (OwnerlAuthdrized A ent Si aqe{ <br /> Date'/ (Revised 9/23/2016) U <br />