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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETf,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> � �� �h��, � .: { �..�,��� ����� �Pt�QJE��;SIT���+1F0��1#7'����� �-� � :r,� - v�-��.'. . ;���._�'' <br /> PROJECT SITE ADDRESS:�aD �I a £ PROPERTY TAX#: �� �� �� � <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> . � � , <br /> CONTACT`�1+��'ORINATION-� ;., ' " <br /> OWNER NAME: � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT "'F <br /> CITV � "' STATE ZIP � �D <br /> OWNER PHONE: �-�o[ �� — q OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: sTaeer � <br /> � CITY � STATE ZIP D <br /> CONTRACTOR PHONE: � �,��" CONTRACTOR EMAIL: � � � <br /> CONTRACTOR LICENSE#(REQUIRED): � H {�Y� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)S��jZ� `l V <br /> PRIMARY CONTACTc ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L�2S`� �� � , <br /> �O/l.f/� ��/ �� CONTACT EMAIL: <br /> � i nfa I�yi� h% � =N! a -'�r17�i�Fri�`ar�J c'r . . . tN,t�i i��+�.4s�R' s- - a ; t w a <br /> � a ai +;i:� ���� �;�� � n = �$�l�4�?11�,��P�������APPL�C�ITIO�r��, i� *.0 �- � .�v �_��-�- <br /> Existing Use of Building: Contract Price of Work:$ �_ � � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial �industrial <br /> Type of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ����� .��,V'�-C� <br /> -�� <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> = �` MECHANICAL�PERMIT APPLICA'i'ION ; � '. ; PLUMBIN�'s iPERMIT,A�PLICATION � � <br /> .. . ,.,_ .y�.� ; <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of UyK of Fixtures #°f List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixiures <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 Firepiace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Other: <br /> ���4 a itir x i i �° i o �i , ,i <br /> ��.���",y�i'S�!R1NKM,��;���pa1��S�.�� �G�,� $`T'E1VI,°"i'�� <br /> a ti � ��� ���. , ��� <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 ihis permR must compty with <br /> cunent federal,state,and/ocal law.The granting of a permB onty authorizes approved work and no deviations therefrom.Deviafions must first be authorized in wrfting from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or/am auihorized by the owner of this properry to perform the work for which application is made, <br /> and l comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Officia/Use Only <br /> s. �� � PERMIT# <br /> ����� �� . <br /> Owner/Authorized Agent Signature Date (Rev�sed 10/i2/2015) <br />