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PERMIT APPLICATIO <br /> BUILDI*MECHANICAL/ PLUMBING / SIGN / PRINKLER/ 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 /> PRO ECT SITE AYFRESS: PROPERTY TAX#: <br /> At t.' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: Sk rA 7��'ii1�'I Z-► L <br /> CONTRACTOR ADDRESS: STREET <br /> CITY (,� STATE ZIP VC <br /> CONTRACTOR PHONE: -?-u, l2 � S CONTRACTOR EMAIL: L��L �� 7�r st►1 r"� �. i�ia'�, <br /> CONTRACTOR LICENSE#(REQUIRED): Z-I T/ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): rd 7j 7 <br /> PRIMARY CONTACT: ❑OWNER ®CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: / CONTACT PHONE: <br /> vL✓� � , ? ! > S <br /> '&^J 9���C1 CONTACT EMAIL: c� r f)�wn��f 1/ ✓V�, c <br /> BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: <br /> Contract Price of Work: $ c/ <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. ❑Sin ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn kAlteration _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 Floor Drain <br /> Gas Fireplace Wood Stove 3 Kitchen Sink&Disposal lGrease 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 G <br /> Number of Heads <br /> ACKNOWLEDGEMENT./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 au t rued 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 State Co r tors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> 6 1 <br /> Owner/Authorized Agent Sign lure Date (Revised 10/12/201 ) <br />