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PERMIT APPLICATIOAL <br /> BUILDI*MECHANICAL/ PLUMBING /SIGNI SPRINKLER/ 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> ' i�r'4 `" <br /> PROJECT SITE ADDRESS: 1011-7- 4 'PROPERTY TAX#: <br /> v�?2(�CC 4� l v <br /> LEGAL for new construction: Short Plat/subdivision If Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET ZIFC- //�I�L` <br /> CITY > rL�"GGA" STATE �% ZIP �P-S <br /> OWNER PHONE: EMAIL ' <br /> CONTRACTOR NAME: yr,�?✓� ,ci� ? 1 L� . <br /> CONTRACTOR ADDRESS: sTREEr ` �/'/ <br /> CITYLcl`��u�L STATE �`v je�- ZIP ! �G <br /> CONTRACTOR PHONE > �°J CONTRACTOR EMAIL: (-,I <br /> CONTRACTOR LICENSE#(REQUIRED): ,j. U,�,l/Yj�T 5 �S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):. <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: �l ` LS�n� Iil ".(tfi sem` <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: iContract Price of Work: <br /> Proposed Use of Building: �9�L'�'� � 7 / C' K�.r 1+ eat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-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: �,l <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 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 /> X 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 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/ at 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 Offcial before- g authorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the tate Contractors Law 98.27 RCW and 296.200A WAC. <br /> j City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Auth ized Agent Signature Date (Revis d 9/23/2096) <br /> 4 <br /> l� <br />