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PERMIT APPLICATION <br /> OLBUILDING4&CHANICAL / PLUMBING / SIGN / SONKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S"GREET,EVERETT,WA 98201 <br /> P)425-257-8510 FAX 425-257-3857 1(E)everetteps@evere'twa,gov I Arnnv evere1,14va,W.,0permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJIECIT SITE ADDRESS(, GLO L S� ace �e- PROPERTY TAX#: <br /> LEGAL fut neve const(_}ction: ShortPlaUsubdiv si°n _I r,t No. (attach color of tong legal description, <br /> CONTACT INFORMATION <br /> OWNER NAME: N/ �; { ;. TENANT NAME(If Commercial) <br /> OWNER MAILING ADDRESS: srREET <br /> OWNER PHONE: '"? OWNER EMAIL: <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: ST(t_ET <br /> it L L <br /> Cir( p ) ' { <br /> \^`1s T�'.'`4..,•'� �... STATE �,.`�� ZIP <br /> CONTRACTOR PHONE: t '- '` f c <br /> R EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): �i ' ti 04 �CONTRACTOCITY OF EVERETT BUSINESS l r i g <br /> S LICENSE#(REQUIRED). " ( s <br /> PRIMARY CONTACT: CIO <br /> WNER r ''CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: For" <br /> BUILDING PERMIT APPLICATION <br /> xistln` Use of Building- <br /> Contract Price of Work: S <br /> "roosed Use of Buildin ---JHeat Source: as ❑Electric ❑Other <br /> 3uiiding Typo" FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Gype of Project: ❑New ❑Addition ❑Remodel `Repair ❑T.I. 031 n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> >ESCRIPTION OF WORK <br /> 1SSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: —New — Addn _Alteration _Repair Type of Project: New Addn Alteration Repair <br /> #of '— — — _Repair <br /> List of Fixtures #of List of Fixtures #of List of Fixtures #of <br /> Fixtures Fixtures Fixtures LIst of Fixtures <br /> Fore 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 brain <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/Map/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> �KNOWLEDGEMENT: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 /> irrent 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 /> ulding Official before being authorized under any circumstance.t am the owner.or i am authorized by the owner of this properly to perform the work for which applicalior,is made <br /> id f comply with,the State Contractors Law 18,27 RCW and 296.260A WAC, <br /> City of Everett Official Use Only <br /> plr1 <br /> /4o3 <br /> in oriAuthorized Agent Signature Date (Revised 9,2312f,f b) <br />