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• 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) everettepsOa everettwa.gov I www.everettwa.gov/permits <br />(Blue ®r Black Ink Only Please) PROJECT SOVE INFORMATION <br />,, � <br />PROJECT SITE ADDRESS: ' <br />PROPERTY TAX #: --{9C3' 0 . t <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY d y STATE ZIP" <br />OWNER PHONE: _ <br />OWNER EMAIL: <br />CONTRACTOR NAME:'" ,1 I <br />CONTRACTOR ADDRESS: sTREET <br />CITY STATE WA ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): `- a4tL-•- <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR:OTHER (Please Specify)�j/J _ G?KiiZL�Tt t�.1� <br />CONTACT NAME: <br />�S- - -- k-41 .� <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />Cat <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: ❑Gas Electric ❑O er <br />Building Type: ❑SFR-Detached 59FR-Attached ❑Duplex ❑Multi -Family-# of Units: _ ❑Commercial ❑Industrial <br />Type of Project: ❑New ZAddition ❑Remodel , epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF wr)PIz- _n ,_ n <br />,,ASSOCIATED BUILDING PERMIT # (if applicable): I <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: ILLNew _ Addn Alteration ,-�_ Repair <br />Fix of .s <br />List of Fixtures <br />FiX of� <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Forced Air Systems <br />Unit Heater <br />Gas Piping <br />Boiler <br />Water Heater <br />Refrigeration <br />Gas Fireplace <br />Wood Stove <br />Gas Range <br />Ducting <br />Clothes Dryer Hookups <br />Other: <br />Range Hood <br />Exhaust Fan <br />SPRINKLER I SUPPRESSION <br />SYSTEM <br />Chemical or Water I <br />INo.ofHeads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: -_New _Addn Alteration ' -�_ Repair <br /># <br />Fix, J <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Bathtub <br />Urinal <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Shower <br />Floor Drain <br />Kitchen Sink & Disposal <br />Grease Trap <br />Dishwasher <br />Roof Drains <br />Clothes Washer <br />Medical Gas <br />Water Heater ._ <br />Other: <br />Sink (Service/Bar/Mop/etc.) <br />Other: <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 />J� TE7rT# G� <br />4) <br />nt Signature <br />' Date <br />