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PERMIT APPLICATION <br /> BUILDINe t-t"1ECHANICAL/ PLUMBING / SIGN / tINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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 /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �i�{-��i� � i`�/�"������GII TENANT NAME(If Commercial): <br /> OWNERMAILINGADDRESS: sTREET I�/��.� ��5������-��• `�"' <br /> CITY �VE�//�� �/ STATE �'V�7� ZIP �CJ t�l,C/ � <br /> OWNER PHONE: �0�3 ��'�` 3 5�� OWNER EMAIL: w�� y��E�YC� �''��* � «'`Z� <br /> � CONTRACTOR NAME: b�i 'i--��f� �S��11��PG�i�C� <br /> CONTRACTOR ADDRESS: srReeT <br /> CITY STATE Z�P <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(R[QUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUI LDI NG'PERMIT APPLI GATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: 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. ❑Si n ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �C� �C�C!/��-��'t-1 J��Q''r��� ��i�6�t�'�a'�cc�� '��>��.�.� l�i��� � S��zr�f^�f� Y�.[r)<i� <br /> l <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 Fixtuies #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number 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,sfate,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must firsf be authorized in writing from the <br /> 8uilding O(ficial before being authorized under any circumstance. 1 am the owner, or I am authonzed by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contracfors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Oificial Use Only <br /> �� 3/(//�.� PERMIT# � .�� ��� -- <br /> . � <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) �,� <br /> \�Z ;) <br />