Laserfiche WebLink
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 I www.everettwa.gov/permits <br />(Blue or Black Ink,Only'PleAse) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: PWIMYTAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: TENANT BUSINESS NAME (Commercial): <br />OWNER MAILING ADDRESS: STREET I t <br />CITY STATE W ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET I <br />CITY <br />C <br />(�� STATE ZIP <br />CONTRACTOR PHONE: <br />— <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): L$2.1 <br />CITY OF EVERETT BUSINESS LICENSE #( UIRED . <br />PRIMARY CONTACT: RfOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: 1 <br />CONTACT PHONE:—�Gif♦g <br />CONTACT EMAIL:`CGyVjt <br />BUILDING INFORMATION <br />Existing Use of Building: <br />Contract Price of Work: $ 21 <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU []Multi -Family - # Units: ❑Commercial ❑Accessory Structure <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair [IT.]. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL <br />PERMIT <br />APPLICATION <br />PLUMBING PERMIT <br />APPLICATION <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />Fixture <br />Count <br />List of Fixtures <br />A/C — Air Handling Units <br />Gas Piping <br />Backflow Preventer (Inside Bldg) <br />Shower, Tub, or Combo <br />Boiler <br />Gas Range <br />Clothes Washer <br />Sink -Commercial (3-comp,prep,floor) <br />Clothes Dryer <br />Heat Pump&Ductless <br />Dishwasher <br />Sink -Residential (kitchen,bath,bar) <br />Duct System (Remodel) <br />Refrigeration <br />Drinking Fountain <br />Sink -Utility, laundry, mop <br />Exhaust Fans (Residential) <br />Commercial Ventilatior <br />(Not Heat/AC system) <br />Floor Drain <br />Toilet <br />Exhaust Hood (Type 1) <br />Hose Bibb <br />Urinal <br />Exhaust Hood (Type 11) <br />Water Heater <br />Interceptor -Grease <br />Waste/Water Piping Repair <br />Exhaust Hood (Residential) <br />Wood Stove <br />Interceptor-Sand/Oil <br />Water Service (behind meter) <br />Forced Air Systems <br />Other: <br />Medical Gas <br />Water Valves or Fixtures <br />Gas Fireplace/Insert/Log <br />Roof Drains <br />Water Heater <br />SPRINKLER <br />/':SUPPRESSION <br />SYSTEM - <br />Sewage Ejector or Sump Pump <br />Other: <br />Water Suppression System <br />INo. of Heads <br />Chemical Suppression System <br />No. of Heads <br />ACKNOWLEDGEMENT,1 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 />PER T,#1e <br />S <br />(Revised 10/ 1 U/2018) <br />I <br />a <br />1Z, <br />i1z <br />