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PERMIT APPLICATION
<br /> - BUILDING / �HANICAL / PLUMBING /SIGN /�NKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: � PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: � `� �_ .. ANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReeT �- �d`� �j t,�,
<br /> CIN ��(A,, STATE ZIP
<br /> OWNER PHONE: ��L� ��� — `Q � OWNER EMAIL: �,1r d
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<br /> CONTRACTOR NAME, <�j �_ Q(� � U \ ,01�.�
<br /> CONTRACTOR ADDRESS: srReer
<br /> ciTv �,. ��B ��� STATE ZIP
<br /> CONTRACTOR PHONE: � Q� � CONTRACTOR EMAIL: �
<br /> CONTRACTOR LICENSE#(REQUIRED): � c� �j � CITY OF EVERE7T BUSINESS LICENSE#(REQUIRED): �•�
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<br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) t��.- I
<br /> CONTACT NA E: CONTACT PHONE: L� 5--
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<br /> C2�� �,�` CONTACT EMAIL: � � �' ' �
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<br /> Existing Use of Building: Contract Price of Work: $ d
<br /> ProposedUse of Building: � � Heat Source: ❑Gas L�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 ❑S inkler ❑D olition ❑Change of Use
<br /> DEcro�oTinN nF wna►c� �x��(/` (,�tr �'Qi��` �`��d �� �„ �i`" ��UC o�''�(1J
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<br /> ASSOCIATED BUILDING PERMIT# if applicable):
<br /> ` MEC�fA"N��aL�PE1�N��x'T A�PLI�A7Et'��t �� � ,"fr �=���►L��B�L�C�P,1�[�1��`�PPC��/k���.��� �� ���;'
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<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 /> 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 Kitchen Sink&Disposal Grease 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 /> ; �;;SP�CI�I'�L�1�l��P�,ESS�ON '�`'�STF�.�il, ! �{�',,;
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT:I have revrewed 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 O�cial before being authorized under an circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and I co I with fh State C tra ors Law 18. RCW and 296.200A WAC.
<br /> '� �/ City of Everett Official Use Only
<br /> p� r— �� � � ^ PERMIT# � O �O��
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<br /> l�`� ��A
<br /> Own thorized Agent Signature Date �-' (Revised 9/23/2016)
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