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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4Err 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 i(E)everetteps@everettwa.gov i www.everettwa.gov/permits <br /> (Blue or Black link Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 411LI , �r1, ���� -.> PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. <br /> (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ) TENANT NAME(if Commercial); Z <br /> OWNER MAILING ADDRESS: STREET � � rn a air, <br /> CITY r t <br /> STATE ZIP <br /> OWNER PHONE: ( �c�;�j 1 0 CIZ,0 <br /> =OWNER <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET yjy�} <br /> CITY V STATE �,.'` 2P l`"'• /'l <br /> CONTRACTOR PHONE: _ ( ' <br /> ( CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): t VJ "7 7d CITY OF EVERETT BUSINESS LICENSE#(REQUl12ED): <br /> L10 ?J <br /> PRIMARY CONTACT: ❑OWNER <br /> CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LOIS a <br /> ISP 03y--1 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buiidin Contract Price of Work: $ e <br /> Proposed Use of Buildin : Heat Source: ❑Gas Obectric ❑Other <br /> Building Type- ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units_ <br /> ommerciai ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Sin OS rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK; <br /> T # <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 #of #of <br /> Fixtures List of Fixtures List of Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> AIC—Air Handling Units Fixtures Heat Pump Toilet Backflow Preventer(inside Bid, <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavato Wash Basin Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disptasal Grease Trap <br /> Gas Ran a Ductinq Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran a Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicetBatlMap/etc: {'ether: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <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 /> :urrent 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 /> 3udding 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 /> Ind i comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> I <br /> City of Everett Official Use only <br /> PERMI <br /> l n rlAuthorized Agent Signature Date (Revised 9/22t316 <br />