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PERMIT APPLICATION <br /> BUILDING WECHANICAL/PLUMBING/SIGN/OUNKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION , <br /> T <br /> PROJECT SIDD SS:im- PROPERTY TAX <br /> a �� v <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION' <br /> OWNER NAME: d>j TENANT NAME(If Commercial): , <br /> OWNER MAILING ADDR SS: STREET P0 <br /> CITY S*-) )" ; STATE to ZIP <br /> OWNER PHONE: j-f a (p OWNER EMAIL: <br /> CONTRACTOR NAME: N S C., <br /> CONTRACTOR ADDRESS: STREET O <br /> CITY STATE A ZIP <br /> CONTRACTOR PHONE:Wls - I— ONTRACTOR EMAIL: 14a (,J Q- S (@ r <br /> CONTRACTOR LICENSE#(REQUIRED): (,7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR Id OTHER(Please Specify) -.fin ani <br /> CONTACT NAME: CONTACT PHONE: I- TSS 123 <br /> CONTACT EMAIL: "lv,ul <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building- 1 <br /> Contract Price of Work:$ UC) <br /> Proposed Use of Building: Cmet I er�1�1 S Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. JUSign ❑Sprinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT 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 <br /> List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units 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 Ductinq Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> ,Range Hood Water Heater Other: <br /> Exhaust Fan I Sink Service/Bar/Mo lett. Other: <br /> SPRINKLER I SUPPRESSION SYSTEM' <br /> Number of Heads J I I <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 Oficial 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 /> S)(90R n({ <br /> Owner/Autho e'd Agent Signature Date (Revised 10/12/2015) <br /> � �2 <br />