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r ' PERMIT APPLICATION <br /> BUILDING-- IECHANICAL / PLUMBING /SIGN." 'RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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: IC—1c �� _J ��� PROPERTY TAX#: <br /> J J GL s iYf ` <br /> LEGAL for new construction: Short Plat/subdivision � �. Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A � p },: , j �, TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY yf K�(�A STATE h ZIP IWO r? <br /> OWNER PHONE: LfK-7ii 1711, OWNER EMAIL: j�t,�/:�'r�� f•�y , � � � yyEk;�.�p y�,, <br /> CONTRACTOR NAME: 'C'�? (' �;s„P f`'p;a L L- k. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY - t STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:O7 OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 4CONTACT PHONE: <br /> { CONTACT EMAIL: ,F <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Y Contract Price of Work:$ <br /> Proposed Use of Building: `p <br /> Heat Source: fZGas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: 0New ❑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 0 Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub r Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) r` Drinking Fountain <br /> Water Heater a Refrigeration Shower Floor Drain <br /> Gas Fireplace >, Wood Stove ` Kitchen Sink&Disposal [ Grease Trap <br /> I Gas Range Ducting f Dishwasher (? Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer c Medical Gas <br /> Range Hood -— Water Heater Other: <br /> -� Exhaust Fan a Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:t 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) ``� <br />