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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOL1710N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS� � � �i� ���� PROPERTY TAX#: � � � U �/ <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: y Y1� TENANT NAME(If Commercial): � <br /> OWNER MAILING ADDRESS: sTRee ` ,�� �, f �/� � ���� � � � L C��� <br /> ��Ty � STATE �� ZIP / <br /> OWNER PHONE �i OWNER EMAIL:��'� ;� / � �/�, G� <br /> CONTRACTOR NAME: �V� �"� I �,�� <br /> CONTRACTOR ADDRESS: sTReev��� � �, �� ��'�� � <br /> / r" <br /> L � <br /> CITY � � { � STATE� Zlf' �� �� <br /> CONTRACTOR PHONE� � �� a �i 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: � � � ,��-�� �il Contract Price of Work:$ '�- <br /> Proposed Use of Building: � � � Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New 1 Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> vv}� C.�� �Y v� C������ T <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 Fi�ctures #�f List of Fixtures #of List of Fintures #of List of Fi�ctures <br /> Fi�ctures Fixtures Fiztures 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: � 56 <br /> s��aoea����a i�u���a�sso�� �xs-e-�� <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 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.Deviafions must first be authorized in writing from the <br /> Building Officia!before being authorized under any circumstance.l am fhe owner, or I am authorized by the owner of this property to perform fhe work for which application is made, <br /> and omply with the State C lractors Law 18.27 RCW and 296.20oFl WAC. <br /> � L� City of Everett Official Use Only <br /> // <br /> �� �� /i )��,�� � ��l� � #�C�C� Q � <br /> Owner/Authorized Agent Signature Date (Rev�sed 5/20/2016J <br />