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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREF_T, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReer <br />C�7y STATE ZIP <br />C�P�9►1�:a�.(�7►1�A <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: sTReeT <br />CITY <br />CONTRACTOR PHONE: <br />CONTRACTOR LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR <br />CONTACT NAME: <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached ❑SFR-Attache <br />Type of Project: ❑New ❑Addition ❑Remodel <br />DESCRIPTION OF WORK: 1 <br />�� �wr`-� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />OWNER EMAIL: <br />STATE <br />ZIP <br />CONTRACTOR EMAIL: <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICA' <br />Contract Price o, <br />Heat Source: <br />d ❑Duplex ❑Multi-Family-# of U <br />❑Electric ❑Other <br />❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑ <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fi�ctures List of Fixtures Fi�ctures Lisf of Fixfures <br />A/C —Air Handling Units Heat Pump <br />Forced Air Systems Unit Heater <br />Gas Piping Boiler <br />Water Heater Refrigeration <br />Gas Fireplace Wood Stove <br />Gas Range Ducting <br />Clothes Dryer Hookups Other: <br />Range Hood <br />Exhaust Fan <br />SPFtINI�(LEit / SIJPPF2�SS1Af�1 SYSTEM <br />Number of Heads <br />LI Industrial <br />of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fi�ctures # of List of Fixtures <br />Fixt�res Fixtures <br />Toilet Backflow Preventer (Inside B <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 />5ink (Service/Bar/Mop/etc.) Other: <br />� _ A . . r� � � i <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 /aw. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must firsi be authorized rn writing from the <br />8uilding Official before being a�thorized under any circumsfance. I am the owner, or I am aufhorized by the owner of this property to perform fhe work for which application is made, <br />and I comply wiih the State Contractors Law 98.27 RCW and 296.200A WAC. <br />, , �, City of Everett Official Use Only <br />/ / �� " � PERMIT �, � C � <br />� <br />Agent Signature D te Revised 5/20/ 016) <br />� �� <br />��� <br />