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• PERMIT APPLICATION • <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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE AD RESS: PROPERTY TAX#: <br /> I <br /> LEGAL for new construction: Short Plat/subdivision—Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: fJaW5wA Pict,- CW0 Advac4,- r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ISW GaI•�Mi'a� `_/A <br /> A <br /> CITY F'Ve re� v STATE ZIP 6\%7,3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ;et <br /> CONTACT EMAIL: <br /> BUILDING'PERMIT APPLICATION <br /> Existing Use of Building: 6�C�lc� Contract Price of Work:$ <br /> Proposed Use of Building: ,c2 Heat Source: ❑Gas E]Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ElAddition 5Remodel ❑Repair 11T.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ff11 <br /> New WiY�Ows a�� eK�eCtby- 'fr vid <br /> 'sr, upgrades in�lv�v� hew COwbe"es . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION'; PLU'MBIN,G PERMIT:APPLICATION <br /> Type of Project: New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of List of Fixtures -#--Of List of Fixtures <br /> List of Fixtures Fixtures List of Fixtures Fixtures Fixtures <br /> 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 /> SPR1NKLER.F.SUppPt.SS1M 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 1 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. City of Everett Official Use Only <br /> PERMIT 7 47--) <br /> Owner/Authorized Agent Signat De (Revised 10/12/2015) <br /> %} <br /> t I , <br />