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PERMIT APPLICATIOAI <br /> BUILDINC ECHANICAL / PLUMBING / SIGN 'RINKLER / DEMOLITION <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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ( C'C"C� �� � ,'� ' s PROPERTY TAX#: <br /> � <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:� , � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT I D� I � �L � <br /> CIN STATE ZIP � � <br /> OWNER PHONE:� , •- - ���� OWNER EMAIL: Gf�(j�� ' � ' v— <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: srReEr <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 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: 9 S. '�� <br /> CONTACT EMAIL: d - ` � � ��;� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 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 Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: `��� ` , n� '�} <br /> � J JJ-�-C� I C� �� �( , � �� <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 #�f List of Fixtures #°f List of Fixfures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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 /> Nurnber of Heads <br /> ACKNOWLEDGEMENT.•1 have revrewed 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 Officia!before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perforrn the work for which application is made, <br /> and I com with the State Contractors Law 98.27 RCW and 2 OOA WAC. <br /> Cify of Everett Official Use Only <br /> PERMIT# <br /> ;, ��.--�-�, ,� �� ���� -c� � <br /> O r/Authorized Agent Signature D e' (Revised 90/12/2015J �`/ <br /> �' "I Z' . <br />