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PEF2MIT APPLICATION <br /> BlJILDING / MECHAIVICAL / PLUMBING /SIGN /SPRINI4LER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 1 ... (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) �ROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ���� B ��'�r �`} � e� l��}�C� � � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision �� 1 Lot No.'�(attach copy of Iong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � f� "� ; �'1�� �� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREer ��- ��� ;��v �' � �'(!(�u V � �� � �� <br /> cirv ��=�. '�— STATE . ZIP ���G �J `=n <br /> c, ' •' <br /> OWNER PHONE: �,� t��� � -� ` �� � f�> '� OWNER EMAIL:� Q� , � ' �� �) 1 (1 ���if.� c `. '1 6J v`j <br /> CONTRACTOR NAME: (�,��� '1 " ,� � i b"� �'� 6�, "� � <br /> CONTRACTORADDRESS: srReeT � �� ��' �' <br /> �� <br /> CITY ��� �� � d�`w�� STATE ZIP � � � � (/y <br /> CONTRACTOR PHONE: Z ��,� � --c;� �� � CONTRACTOR EMAIL: �: � , •� ��'� ' & <br /> r� ` <br /> CONTRACTOR LICENSE#(REQUIRED): �'� ��� �`� � 1 ��-� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C , � � ��y� <br /> PRIMARY CONTACT: ❑ OWNER ,�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: sQ�'� �j`' �,? — �'��. '� <br /> ��"� '��'✓�,�'L '�°C��r�4 v� CONTACT EMAIL: �) • f� f�l � � d h:' � ` e � � � <br /> BUILDING PERMIT APPLICATION ��b`� <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> 8uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign prinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF ORK: � <br /> 5 ����� '�3Mr�� �� �e ���� i� �- � �r� ��� �t� 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 Fixfures #of List of Fixtures #of List af Fixtures #of List of Fixtures <br /> Fixtures Fixfures 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 /> Number of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this pe�mit must comply with <br /> current federal,siate,and/oca/law. The grantinq of a permit only authorizes approved work and no deviations therefrom.Deviations must first be autho�ized in writing from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this p�operty 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 /> . � �z�� I � <br /> O erlA thorized Agent ture Date (Revised 5/20/2016) <br /> i � � <br />