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PERM11ARPLICATIOk <br /> BUILDIN. VIECHANICA / PLUMBING SIGN . . ' 'RINKLER/ DEMOLITION <br /> CITY Cr c err r� IT SERVICES <br /> Ev 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 /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision-U! t\i/ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): m t <br /> OWNER MAILING ADDRESS: STREET 12 0 C 'Q , <br /> CITY <br /> STATE VS ZIP Cf <br /> OWNER PHONE: S ' OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY Ph I STATE kJV ZIP <br /> CONTRACTOR PHONE: ` r. 7 �7 CONTRACTOR EMAIL: — <br /> CONTRACTOR LICENSE#(REQUIRED): C \� ^ CITY OF EVERETT BUST SS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CON ACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> t��G kj CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ` <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. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1,,�,,, <br /> I'1 P ��'V rte' , �' l ►' tiU�,{�tCe� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 123 <br /> MECHANICAL PERMIT APPLICATION: PLUMBING PERMIT.APPLICATION <br /> Type of Project: New _ Addn _Alteration _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 /> NC—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 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood I Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER[:SUPP.RESSION 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 /> 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 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 /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> `-� PERMIT# 0 <br /> o � A <br /> Owner/Authoriz�Agent Signature Date (Revised 10/12/2015) <br />