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PERMIT APPLICATION <br />BUILDING / 'HANICAL / PLUMBING / SIGN / SI , NKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 426-257-8857 (E) everattepsQeverettwa.rgov I www.averettwa.gov/permits <br />T�'1i <br />RMEGT SITE ADDRESS: bww, -e`mveo �t � <br />PROPERTY TAX #: <br />EGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />..,. ,, :•.: ,,:: ,•,. • T <br />IWNER NAME: %� TENANT NAME (If Commercial): <br />IWNER MAILING ADDRESS: STREET �, A tl Cr <br />CITY STATE ZIP <br />)WNER PHONE: ci0�2� OWNER EMAIL: <br />:ONTRACTOR NAME: <br />:ONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />;ONTRACTOR PHONE: CONTRACTOR EMAIL: <br />;ONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />'RIMARY CONTACT: OWNER L3 CONTRACTOR III OTHER (Please Specify) <br />;ONTACT NAME: <br />CONTACT PHONE: o"b <br />CONTACT EMAIL' <br />Q <br />N ii <br />Existinq Use of Building: Contract Price of Work: $ <br />'roposed Use of BuildingHeat Source: ❑Gas []Electric [10ther <br />3uildinq Type: ❑SFR-Detached IISFR-Attached ❑Du Iex ❑MtUIti-Family-# of Units: ommercial E]Industrial <br />Type of Project: C11New ❑Addition ❑Remodel ❑Re air LIT,1- ❑Sin ❑S linkler ❑Demolition ❑Chan e of Use <br />DESCRIPTION OF WORK: <br />Toq (ot/-e/- tuw(alr /f ll <br />ASSOCIATED BUILDING PERMIT # (if applicable); <br />aP .U;i►1Fi� hi(3'. P RN! T ApPL1CA`1"fON; <br />k1AEG�1ANf., Al 4 .oM17:.ARP IC/ `r QN <br />Typo of Project: JNew _ Addn _Alteration _Repair <br />Type of Project: New _Adds ,_Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />of <br />Fixtures <br />List of F;xtures <br /># of <br />FixturoS <br />List of Fixtures <br />A/C — Air Handling Units <br />Heat Pump <br />Toilet. <br />Backflow Preventer Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Plpinq <br />Boiler <br />Lavatory Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Ishower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />lClothes, Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />is <br />Exhaust Fan <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />3PR <br />K. /;SU�*P�SyOfi <br />SX'EilY1, ..., <br />Number of Heads <br />ACKNOWLEDGjEMENT: t 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 s permit only authorizee approved work and no deviationS therefmm. Deviations must first be authorized in writing from the <br />Building 0ff1cial before being authorized under any Clrcumstanoe. I am the owner, or I am suthorized 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 />owner/Authorized Agent Signature <br />Date <br />City of Everett Otrcial Use Only <br />(Revised /0/92/2015) <br />