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PERMIT APPLICATION <br /> BUILDING`ECHANICAL / PLUMBING / SIGN fRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: L( V E S Q • p ' PROPERTY TAX#:C?Crz t J160b <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> TENANT NAME(If Commercial): <br /> STREET - C •S ° L' <br /> STATE ,f ZIP S3 <br /> , OWNER EMAIL: <br /> STREET I �l <br /> CITYt H C j STATE �� ZIP <br /> CONTRACTOR PHONE: .3 6 C 3q,) C ICONTRACTOR EMAIL: S q r <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: C OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Contract Price of Work: $ Ci <br /> Heat Source: ❑Gas ❑Electric ❑Other <br /> Attached ❑Duplex Multi-Family-#of Units: []Commercial ❑Industrial <br /> .;lion El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> oUILDING 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 /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of 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 /> Refrigeration Shower Floor Drain <br /> Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Ducting Dishwasher Roof Drains <br /> _ Other: Clothes Washer Medical Gas <br /> Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SUPPRESSION SYSTEM <br /> Number of Heads <br /> -NT:!have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> 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.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 1 comply with the S tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner ut i Jibrized ent Signature Date (Revised 5/20/2016)/ <br /> i !/ <br />