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PERMIT APPLICATION <br /> BUILDING / .::=:.HANICAL I PLUMBING /SIGN /SF RIIIIKLER/ DEMOLITION <br /> 4*7T CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 1(E)everetteps@everettwa.gov J www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �;111,1111111 11 ItF J.. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME. 'DUPen TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET Cl(P 2 vZ S <br /> tqt <br /> Tv <br /> STATEWO 2o <br /> OWNER PHONE: {$ ( Q3 OWNER EMAIL: <br /> CONTRACTOR NAME: T <br /> CONTRACTOR ADDRESS: STREET L ) ' ,• <br /> CITY .--•• ,•„�i STATE ZIP <br /> �, ".`—Z ZIP <br /> •�°� <br /> CONTRACTOR PHONE: {, z { CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIREQ): C,i/_"k44,041(b"7 7A V1 CITY OF EVERETT BUSINESS LICENSE#(REOUIREQ): _G10Z S <br /> PRIMARY CONTACT: ❑OWNER 'CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> e s. �•� Wit.. <br /> "I <br /> CONTACT EMAIL:Y ' [� l <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buildin Contract Price of Work: $ <br /> Proposed Use of Bulldin : Heat Source: Gas ❑Electric ❑Other <br /> Building Type, t FR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units. ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan a 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: Now _Addn _Alteration _Repair <br /> #of Lis t of Fixtures #of #of #of <br /> Fixtures Fixtures List of Fixtures Fixtures Fixtures List of Fixtures List of 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 Boder Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater "Ductin <br /> Shower Floor Drain <br /> Gas Fireplace Kitchen Sink&Disposal Grease Trap <br /> Gas Range Dishwasher Roof Drains <br /> Clothes Dryer Hookups Clothes Washer Medical Gas <br /> Ran a HoodWater Heater Other:ExhaustFanSink Service/Barlmo fetc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Numtrer of Reads <br /> 7CKNOWLEDGEMENT.!havereviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> :urrent 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 /> 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 /> 4 1 City of Everett Official Use O <br /> nly <br /> NM19= `qO O <br /> wneriAatharized Agent Signature R <br /> Date (Revised 912312016) <br />