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PERMIT APPLICATION <br /> BUILDIKJOMECHANICAL/ PLUMBING /SIGN&RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE'INFORIMATION <br /> PROJECT SITE ADDRESS, PROPERTY TAX#: <br /> LEGAL for new construction: ShortPlat/subdivision Lot No. (attach copy of long legal description) <br /> ;CONTAOT'INFORMATIO:N - <br /> OWNER NAME: , TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET 11�__ <br /> CfTY <br /> STATE 4 . ZIP / <br /> CONTRACTOR PHONE: r� CONTRACTOR EMAIL: �1Sh <br /> CONTRACTOR LICENSE#(REQUIRED): ^ ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): W . <br /> PRIMARY CONTACT: ❑OWNER X�ONTRACTOR EI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 21 R 3 <br /> 1 CONTACT EMAIL: /I u <br /> BUILDLNG'_PERMIT APPLICATION. <br /> Existing Use of Building: /A 21til Contract Price of Work:$ r <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex _ulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ElAddition ©Remodel epair 13T.1. 08ign OSprinkler ElDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ;'MECHANICAL PERMIT APPLICATION <br /> PLUMBIINC 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 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 Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLE111:1:;S <br /> Number ot 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.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. Cityof Everett Official Use Only <br /> Owner/Authorized Agent Signature Dae (Revised 10/1212015) <br /> Yz— <br />