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PERMIT APPLICATIO <br /> BUILDIN*ECHANICAL / PLUMBING / SIGN RINKLER / 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: cY`� PROPERTY TAX#: <br /> LEGAL for new construction: Short Platfsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ^ JR TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET O-F <br /> CITY STATEWH <br /> OWNER PHONE: lqc�S 3sl ©vOWNER EMAIL: <br /> CONTRACTOR NAME: CM l <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE WH— ZIP <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: i <br /> CONTRACTOR LICENSE#(REQUIRED): �C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAM CONTACT PHONE: 1 <br /> Mf Q�-CONTACT EMAIL: rW4e ft <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ Cca—"Lf, <br /> Proposed Use of Building: Heat Source: 14Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached ❑Duplex []Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ;]Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �1 � �- 13 <br /> S - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn )d 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 I 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 /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of 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 1 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 /> Owner/Authorized Agent Signature V Date (Revised 10 12/2015) r <br />