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PERMIT APPLICATION • <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER EMOLITIO <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 I www.everettwa.gov/permits <br />(Blue or Black,lnk Only Please) PROJECT SITE INFORMATION, <br />PROJECT SITE ADDRESS: Gf <br />1 <br />PROPERTY TAX #: t f+rG1% <br />.-AV <br />LEGAL for new construction: Short Plat/subdivision 4 b Lot No. (attach copy of long legal description) <br />CON'ACT, INFORMATION:. . <br />OWNER NAME: TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITYSTATE • ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: . <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR JXOTHER (Please Specify) 7FC7. <br />CONTACT NAME: <br />CONTACT PHONE: <br />CONTACT EMAIL: Q <br />BUILDIi�tG P.ERM17`APPLICA ON, <br />Existing Use of Building: / <br />Contract Price of Work: $_ <br />Proposed Use of Building: R41 QPX& Zd"40�/ <br />Heat Source: JKGas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi -Family-# of Units: 0commercial ❑Industrial <br />Type of Project: Mew ❑Addition temodel ❑Repair ❑T.I. ❑Sign []Sprinkler emolition ❑Change of Use <br />DESCRIPTION OF WORK: Pr,�N , C�,l� y.� �• <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />:MECHANICAL PERIYIITAPPLICATION ! <br />PLUMBING PERMIT.APPLICA?ION <br />Type of Project: _New _ Addn Alteration _Repair <br />Type of Project: _New Addn Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink Service/Bar/Mop/etc.) <br />Other: <br />$PRlNICI:ER <br />1$UPPRESSION SYSTEM; <br />Chemical or Water <br />No. 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 1 comoly with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PER IT # <br />(Re vi d 9V231201 ) <br />VZ <br />