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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING /SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4e7r 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ( � (. V i-fX- WPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: caTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 46- 5n I o a w Q } <br /> CITY -ere. TATE tJ3 0 ZIP CIG.�V <br /> OWNER PHONE: t3 • L+ 3Q OWNER EMAIL: <br /> CONTRACTOR NAME: ` ' -ea L r) C E� <br /> CONTRACTOR ADDRESS: STREET `-}�/� �/ p � <br /> CITY (,�"Z. ! t STATE �� ZIP T f3 �1j� `' <br /> CONTRACTOR PHONE: — CONTRACTOR EMAIL: oy � hivi Y CGS , -t' <br /> CONTRACTOR LICENSE#(REQUIRED): 00 CA '?44 3CITY OF EVERETT BUSINESS LICENSE#(REQUIRED4) J--)4 I <br /> PRIMARY CONTACT: ❑OWNER RONTRZTOR ❑OTHER(Please Specify) <br /> CONT CT NAME: p CONTACT PHONE: .;;1 <br /> C SOYA '� �C CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ r. <br /> Proposed Use of Building: Heat Source: Was ❑Electric 11 Other <br /> Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: []Commercial ❑industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel EKepair ❑T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> 1 )K-e I r­� �Je­t n �a �rf r-'�C4 c-if <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 #of List of Fixtures #of List of Fixtures <br /> Fixtures 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 Trap <br /> Gas Ran a 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 I 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,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.K am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Signature Date (Revised 9/2312016) <br />