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PERMIT APPLICATIO <br /> BUILDINOMECHANICAL I PLUMBING / SIGN I PRINKLER / 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@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE:INFORMATION . <br /> PROJECT SITE A RESS PROPERTY TAX#: <br /> LEGAL for new construction: ShoA Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFOR..MATIO.N <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY _ c-A STATE (AD ZIP Z <br /> CONTRACTOR PHONE: 2 - _ -rjZ CONTRACTOR EMAIL: a 17wr h • , ) <br /> CONTRACTOR LICENSE#(REQUIRED): j�L� 1�L (!L CITY OF EVERETT BUSINESS LICENSE#(REQUIRE <br /> PRIMARY CONTACT: D OWNER ONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: LI 2 —-Z Z c) <br /> _ CONTACT EMAIL: L� �) cx Y,� C. <br /> BUILDING' <br /> PER : AP..PLICATION. <br /> Existing Use of Building: Contract Price of Work:$ > <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: OSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ClCommercial ❑Industrial <br /> Type of Project: ❑New MAddition ©Remodel ORepair OT.I. G15ign OSprinkler ClDemolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT\#(if applicable): <br /> MECH. ANICAL <br /> PERPPLICATPLUMBING PERMIT APPLfCAT10N_ <br /> Type of Project: _New Addn _Alteration _Repair Type of Project. _New _Addn _Alteration _Repair <br /> #of #of List of Fixtures #°f List of Fixtures <br /> 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 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/SUPPRESShON_SYSTEM: <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•1 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 t 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 Only <br /> PERMIT# <br /> caner/Authorized Agent Signature Date (Revised 10/12/2015) <br />