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0 PERMIT APPLICATIOV <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 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: (pLya' 13 i 1PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision — Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: /�p ( ;�(�" 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (p j ��rlr� <br /> CITY \ STATE ZIP 77 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET Olga) ISi� <br /> CITY 4+kz STATE ZIP 9 OG <br /> CONTRACTOR <br /> CONTRACTOR PHONE: j' CONTRACTOR EMAIL: c - <br /> CONTRACTOR LICENSE#(REQUIRED)::5�f-A-t-iA4zxjf O�7/ CITY OF EVERETT BUSINESS LICENSE#(REQ ED): 03 <br /> PRIMARY CONTACT: ElOWNER ZZ15NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: l I <br /> ---F r L CONTACT EMAIL <br /> BUILDING PERMIT APPLICATION <br /> i <br /> Existing Use of Building: Contract Price of rk:$ PH"I <br /> Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family of Units: rcial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑SignDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 `of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fix of List of Fixtures Fixtures List of 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/ SUPPRESSION SYSTEM <br /> Chemical or Water I I No. 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> P IT <br /> g' � ala 1 rn <br /> Owner/Authorized Agent Signature Date z (Revised 9/23/2016) <br />