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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 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: .J �'- lh� ✓ G`�� TENANT NAME(If Commercial): lG 5 <br /> OWNER MAILING ADDRESS: STREET Zf'-- / "-/ <br /> CITY �nG� STATE ZIP �o <br /> OWNER PHONE: ,. lrfi 7�%�' 1L �Z- OWNER EMAIL:' <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: STREET L�,`L Z� /,/ <br /> CITY G K!I��LL.- STATE ✓v ZIP <br /> CONTRACTOR PHONE: 7S!!'3��rJ CONTRACTOR EMAIL: diuws�� f•�r1 � � f, ' <br /> CONTRACTOR LICENSE#(REQUIRED): 1p-#-:� O rU M-T F CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): O 151� llo <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �� -3S <br /> ZC /ivla CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 7�� ontract Price of Work:$ <br /> Proposed Use of Building: 64YL4- JZc J / --ZZ,d- eat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑ FR-Attached []Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING�ERMIT#(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 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 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 No. 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 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 bei' thorized 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 t comply with th ate ontractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> :37/ 10 19 <br /> PE MIT# <br /> Z"."'/ <br /> Owne orized Agent Signature Date (Revised 9/23/2016) <br /> i/ <br /> I,? <br />