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PERMIT APPLICATION <br /> BUILDINC . _-_ECHANICAL / PLUMBING / SIGN / ;:INKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 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: j PROPERTY TAX <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �-� (� { ? TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY E 9 i Q'' STATE \/J A <br /> OWNER PHONE: L -` ,Oo - QA I OWNER EMAIL: 1 t �` T LC%'N-� <br /> CONTRACTOR NAME: 0 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ©OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: � ;\� �:� i Contract Price off�� Work: $ ' c) <br /> Proposed Use of Building:`' � \v � t ��(, Heat Source: Iwas Lilectric ather <br /> Building Type: C FR-Detached` FXIFR-Attacked nuplex Dllulti-Family-#of Units: Elommercial Ondustrial <br /> Type of Project: DJew E�ddition Rtemodel aepair D.1. E33ign Elprinkler Ebemolition 12hange of Use <br /> DESCRIPTION OF WORK: <br /> I�JhC�i Cx,'Jz:.�'L. � / L?v1t,�c�`�C vk.\� . <br /> L2ms. ed <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. 1 am the owner, or/am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the tate Contractors Law 18.27 RCW and 296.200A WAC. <br /> -, City of Everett Official Use Only <br /> /7 PERMIT# <br /> caner/Authorized A nature Date (Revised 9/23/2016) <br /> 1- <br />