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U ORIGINAL <br /> 41"7" 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 I FAX 425-257-8857 I (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i , i (/ I C7 { kPR <br /> '\ OPERTY TAX#: <br /> LEGAL for new construction: Short Platt/subdivision Lot No. (attach copy of long legal description) <br /> J CONTACT INFORMATION <br /> OWNER NAME: (l'C vi- 1Jt1(, 1-e-L'i TENANT NAME(If Commercial): <br /> U% <br /> OWNER MAILING ADDRESS: STREET , ' L1 0Sr- <br /> CITY <br /> .C17TYA/t,re-� t 4 STATE IAZIP JC .L.------ <br /> ` v '2j <br /> OWNER PHONE: 2- ' r 1 \ —11 3 CI OWNER EMAIL: V\ L C4 VVV <br /> CONTRACTOR NAME: /i �p n VV\. --- .. .,L <br /> CONTRACTOR CONTRACTOR ADDRESS: STREET -7 1 i Le 7 Z- Jf " (�i J i,\_, +r 1 <br /> CITY I\JAL STATE ZIP C �]j L4 <br /> CONTRACTOR PHONE:`-i-/')-`l- 1 ( —1 \_61 CONTRACTOR EMAIL: \;1 ( C'( JJJ <br /> CONTRACTOR LICENSE#(REQUIRED): I- L-L i- -k---)•-• . 5 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):l',_ --:-)- <br /> ) ' L- <br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: \ CONTACT PHONE: LI -- •' f ` \. ?� GI <br /> ,tl } G1.A l v q. ,. CONTACT EMAIL: n. t M <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ I `i-- ° ? <br /> Proposed Use of Building: Heat Source: ) Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New tjAddition 0 Remodel 0 Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ( 1 (vl ✓\ci , ✓Y1a-( B lAJOAJ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn -y 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 /> NC—Air Handling Units I 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 /> 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/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 /> PERMIT <br /> ( � ( ( L-f ( ( � 1 <br /> nil ), ' O_, 4 <br /> Owner/Authori3ed-Agent Signature, Date (Revised 10/12/2015) <br /> -- -- J <br />