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0 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRE S: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> I <br /> OWNER NAME: �G�,. �,A c' ¢,r n' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: S a a J OWNER EMAIL: <br /> CONTRACTOR NAME: 1t, r- <br /> CONTRACTOR ADDRESS: STREET '3 �.E �/G/{ -Yct GQ J� <br /> CITY Le,r ✓'T`�i f<K.�] STATE �A ZIP <br /> CONTRACTOR PHONE: I CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): (AA1,.r 6P'-.7( C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) i <br /> CONTACT NAME: CONTACT PHONE: L -] <br /> w r CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION 1 <br /> Existing Use of Building: {S Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: as El Electric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair [IT.]. ❑Sin ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ( /r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> i <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 #of List of Fixtures #of List of Fixtures <br /> i <br /> Fixtures Fixtures Fixtures Fixtures <br /> i <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 /> x <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.l 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.Deviations must first be authorized in writing from the <br /> Building 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 /> and I comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> /1A 1 -10 -7 C� <br /> caner/Author' d g t ignatur Date (Revised 10/12/2015) <br /> I <br />