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PERMIT APPLICATION <br />BUILDIN�ECHANICAL / PLUMBING / SIG�RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVIC <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: PROPERTY TAX #: <br />" .� �c C�� � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �,.� -� � TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReer ` • � � <br />CITY STATE � ZIP \"% <br />OWNER PHONE: �=7- �, � - OWNER EMAIL: <br />CONTRACTOR NAME: � � � '1r� <br />CONTRACTOR ADDRESS: srReeT V ' �,� � �, <br />CITY � STATE ZIP <br />CONTRACTOR PHONE: - � - CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): � � � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): � �' <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �� _ <br />�������� � CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ <br />Proposed Use of Building: Heat Source: QGas ❑Electric ❑Other <br />Building Type: C�SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition C'�Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />���.����. ���� �'�l'�I � <br />ASSOCIATED BUILDING PERMIT # if applicabie : <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fiartures # of Lisi of Fixtures <br />Fixfures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <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. 1 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 />Agent Signature <br />Date <br />City of Everett Official Use Only <br />PERMIT # <br />��� � C� � <br />(Revised 10/12/2015) <br />