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PERMIT APPLICATIOt <br /> 4 BUILDIN IAECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION <br /> err CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 [(E)everetteps@everettwa.gov i www.everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS; LklPROPERTY 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 t <br /> CITY STATE U0 ZIP <br /> OWNER PHONE: (d OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET (L4 t L L;6, (rCITY ,,. <br /> `� '{ - STATE 4 4'r1 ZIP c 'c 4 4 <br /> CONTRACTOR PHONE: –I C4` _ C( � ? CONTRACTOR EMAIL: 0 Lez <br /> L.:: C, r <br /> CONTRACTOR LICENSE#(REQUIRED): ( b '� k , �" <br /> Y'� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 16 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: - <br /> CONTACT EMAIL:V W4a'2 i( c' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$—,(e 24 <br /> Proposed Use of Building: Heat Source as ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: []New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> /�n <br /> ASSOCIATED BUILDING PERMIT#(if applicable)-._ <br /> MECHANICAL PERMIT APPLICATION i PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures -#Of #of <br /> Fixtures Fixtures List of Fixtures #of List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> AIC-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 Qrain <br /> Gas Fire lace 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(ServicelBar/Mopletc.) Other <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and ct. Work done pursuant to this permit must comply with <br /> :urrenl federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefromorrec.Deviations must first be authorized in writing from the <br /> 30ding 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 /> ind I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> / <br /> PERMIT# City of Everett Official Use Only <br /> j�r�tL,._.—_�� I .._. <br /> AwiiuriAuthorlxed Agent Signature D ` <br /> ate (Revised 912311,306) <br />