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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> .4414 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black InkOnly;Please) PROJECT•SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2.3 2_5 fj r, , PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT;I N FO RMATIO Nh <br /> OWNER NAME:RI C ht4R.r'W /tZV/*f/ P06177>' J, EEK *TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET a a 0. .y�O)C 54 2,-7 <br /> CITY STATE tA j - ZIP 9 c ��`�✓ <br /> OWNER PHONE: 42 /5��yy"—__ 7L.7 �- 444 I OWNER EMAIL: pak 8165'2.0 coD�L�'S'1 rt+ <br /> CONTRACTOR NAME: Vl�t,v1c)---.-- <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: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) -/ <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATIO <br /> Existing Use of Building: Contract Price of .rk:$ <br /> Proposed Use of Building: 5 ER_ Heat Source: ❑Ga U.Electri ■ <br /> Building Type: tilSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition VRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 5t / <br /> c(e_ w Yi-(.L S i 4-C LQt', ` icI ri-c )(, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT"APPLICATION „ PLUMBINGGPERM T 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 lP Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems if Unit Heater / Bathtub Urinal <br /> Gas Piping Boiler / Lavatory(Wash Basin) Drinking Fountain <br /> I Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> I Clothes Dryer Hookups Other: f Clothes Washer Medical Gas <br /> Range Hood Other: <br /> 1 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> -SPRINKLER I SUPPRESSION SYSTEM <br /> Number 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 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 /> City of Everett Official Use Only <br /> ( <br /> _wner/Authorized Agent Signature Date (Revised 5/20/2016) l <br />