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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 /> OL (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SIT ADDRESS: PROPERTY TAX#: <br /> o a% -cow - CZA -oo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: R S <br /> CONTRACTOR ADDRESS: STREET v-�-) <br /> CITY a­\' STATE ZIP <br /> CONTRACTOR PHONE: i� cJ Q CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): q a CITY OF EVERETT BUSIN SS LICENSE#(REQUIRED): �5 A-ID llot�- <br /> PRIMARY"CONTACT: ❑OWNER CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: CR e . Ct-,1­� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ \$ 4A 5 Cb t M <br /> Proposed Use of Building: Heat Source: IR6as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Geommercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel CSR T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> L�- &'i \L-�or� '�, C1 \2•S ��n 5 3 �r�5ir. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration ✓Repair!R+ 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 lGrease 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 /> Number 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 federa d local . The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Offi ral before bei gat nzed 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 I com y with the Sta C n ctors Law 18.27 RCW and 296.200A W <br /> City of Everett Official Use Only <br /> PERMIT# <br /> uthori7dh Ment Signature Dat (Revised 10/12/2015) 9 <br />