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PERMIT APPLICATION BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES 4e7T 3200 CEDAR STREET,EVERETT,WA 98201 (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: I PROPERTY TAX#: LEGAL for new constructlon: Short Plat/subdivision —Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: � (J. TENANT NAME(if Commercial): OWNER MAILING ADDRESS: STREET Ca Co Aic, ctrr STATE OWNER PHONE: t- g q(''1 p` t3WNER EMAIL: CONTRACTOR NAME " CONTRACTOR ADDRESS: STREET 9116Broadq22.W I Tv STATE , ZIP �f CONTRACTOR PHONE: # _ CONTRACTOR LICENSE#(REQUtRED):CM,Y i'M ft% `'6-7Zd n CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): PRIMARY CONTACT: ❑OWNER §6 CONTRACTOR ❑OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: o5 casq CONTACT EMAIL: &-E44-h pmVveaiinq •j0 M BUILDING PERMIT APPLICATION Existing Use of Building: Contract Price of Work: $ L4,000 Proposed Use of Building: Heat Source: Was ❑Electric ❑Other Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famit -#of Units: []Commercial ❑Industrial Type of Project: ❑New ❑Addition []Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use DESCRIPTION OF WORK: JASt6l� �GS w-6-�wtAG-S Its cn o x ASSOCIATED BUILDING PERMIT# if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration _Repair #of #of Fixtures List of Fixtures Fixtures List of Fixtures #of List o1 Fixtures #of List of Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove lKitchen Sink&Disposal Grease Trap Gas Ranqe Ducting Dishwasher RoofDrains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/SUPPRESSION SYSTEM Chemical or Water I 1M. of Heads 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 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 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. and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. a �MK` City of Everett OfficialUseOnt)- Owner/Authorized Agent Signature Date tRevised 9123/201 G)