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elliP. PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <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 1 www.everettwa.gov/permits <br /> (Blue'or Black IInI Only Please) ,k; =PROJECT RI1 jINFQR VIATION �,,,, "�" " i`ta� <br /> PROJECT SITE ADDRESS: /"( /1r Vi,t�GIN, 4J6 PROPERTY TAX#: 4:9054-4'101 !'5. O1 4-00 <br /> LEGAL for new construction: Short Pla✓`t/subdivisio'ns' INEAJ .. f V J. tt f;Lot No.14415Tattach copy of long legal description) <br /> CONTACT INFORMATION <br /> r <br /> OWNER NAME:DA)to 4 ( ?(E (4)f ,E TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ilke, J -• <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> ....,. ,�w � � ,.� <br /> CONTRACTOR.. .. <br /> NAME: OW <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LIC SE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHEk(Please Specify) ��-S,/c <br /> CONTACT NAME: �n CONTACT PHONE: A Z 2_ 2�•7 rt�I <br /> I� ( ,4 CONTACT EMAIL. `T De^� /' �/ kvii (G r cJv- <br /> S,,, V ?' . .,a.r l*ttf NG"PERMiIT APPLICATIO 1 _lt " int zt w <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: ..—f..4, Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project:,lew DAddition DRemodel El Repair ❑T.I. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 7 3F. *AP- '� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> Z MECHANICALL1PERMIT APPLIC ►TION< PLUMBING PERIVIItlAPP,LICATION' <br /> Typ• .f Project: _New _ Addn _Alteration Re r Type of Project: _New _Addn _Alteration _Repair <br /> #ofList of Fixtures #of • t of Fixtures #of List of Fixtures #of List of F.'ures <br /> Fixtures \ Fixtures Fixtures Fixtures <br /> A/C •it Handling Units /Heat Pump Toilet ' - ,,„ Backflow enter(Inside Bldg) <br /> Forced Systems Unit Heater BathtubUrinal <br /> Gas Piping Boiler Lavatory(Wash Bas Dr' ing Fountain <br /> Water Heater Refrigeration Shower " v' boor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal �. Grease Trap <br /> Gas Range N Ducting Dishwasher / 'oof Drains <br /> Clothes D /er Hookups N Other: Clothes Washer Mer. al Gas <br /> Rang7Hood Water Heater Other: <br /> E '-ust Fan Sink(Service/B op/'etc.) Other: �� <br /> MOPRINKLER,$/,SUPPRESSION SlT, <br /> Chemical or Water ' No.of Hea <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the in ation coiined herein is true and correct.Work done pursuant to this permit must comply with N, <br /> current federal,state,and local law.The granting of a permit only authorizes ap 1"faroved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumsta - 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 RC' .nd 2 • 90A WAC <br /> City'ofEverettOfficial Use Only <br /> 1°1°.: <br /> & a Z67 PERMIT ' � l / <br /> Owner/Aut. ge nature Date (Revised 9/23/2016) O7 6 G/ •AN\ <br />