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PERMIT APPLICATION <br /> BUILDIN AEGHANIGAL/ PLUMBING /SIGN .., RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 J FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /03 X11e� I PROPERTY TAX#:wu <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (�/�G jT ��GS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Z '3 /l! U� <br /> CITY -VtSTATE / ZIP <br /> OWNER PHONE: Z — U �3 Z OWNER EMAIL: <br /> CONTRACTOR NAME; ly, L <br /> CONTRACTOR ADDRESS: STREET Z <br /> CITY it,�E' STATE C'U/ ZIP <br /> CONTRACTOR PHONE: S=�� CONTRACTOR EMAIL: ICGr /¢ G toil l C u. L✓l <br /> CONTRACTOR LICENSE#(REQUIRED):,,,(,A1FJL TSL f'7/ C-07- ICITY OF EVERETT BUSINESS LICENSE#(REQUIRE : (0S <br /> PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CO�T NAME: CONTACT PHONE: 2 <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: OGas 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: <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 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 /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water I I No. 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.l am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / 7PERr�� <br /> caner/A1rize Agent Sign ure Date (Revised 9/23/20`16) <br />