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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps c@everettwa.gov I www.everattwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3Z PROPERTY TAX#: <br /> LEGAL for new construction: Short Piattsubdivision _Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 13TENANT NAME(If Commercial): <br /> OWNER MAILING ADORE S: STREET <br /> CRY STATE ZIP <br /> OWNER PHONE: /33 OWNER EMAIL: <br /> CONTRACTOR NAME. CIM H .►i ,l & <br /> CONTRACTOR ADDRESS: STREET '46 Q <br /> CITY STATE �" ZIF > <br /> CONTRACTOR PHONE: �� (� CONTRACTOR EMAIL: V )e- / �iiia r . com <br /> CONTRACTOR LICENSE#(REQUIRED); CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): +( <br /> PRIMARY CONTACT: ❑OWNER 1A CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a5 sq otqFo <br /> CONTACT EMAIL: J& e ke ;tt ,to to <br /> BUILDII+IG PERMIT APPLICATION <br /> Existing Use of Buildin : Contract Price of Work:$ <br /> Proposed Use of Building., Heat Source: ❑Gas Electric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famii -#of Units: ommerciai ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> tRSAA11 010 0� �s5 kQO f P0 VIAf <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 #of <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures 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 Tia <br /> Gas Ran a DuctingDishwasher 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 /> Chemical or Water No.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,slate,and local jaw. 7'he granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Mudding Otf n'al before being authorized tinder any circumstance.I am the owner,or/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 296.200A WAC. <br /> City of Everett Official Use Owy <br /> PERMIT <br /> 1� CQ ,�,LQ11�C tU CcJ <br /> � 1 <br /> OwnOtAuthorizod Agen ignature Dale (Revised 9/23/2016) <br />