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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING I SIGN I 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 /> 2 PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,S5� PROPERTY TAX#: Q 3 <br /> LEGAL for new construction: Short Plat/subdivision° Lot No. (attach copy of long legal description) <br /> I <br /> CONTACT''INFORMATION` <br /> OWNER NAME: ( TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ` c (,t <br /> CITY L 14 11 U'Ct-J / STATE �Gt ZIP <br /> OWNER PHONE: — — OWNER EMAIL: h �Q'� a-fvkct <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 /> I <br /> i <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION i <br /> I <br /> Existing Use of Building: c,Ur�z//? �` Contract Price of Work: <br /> Proposed Use of Building: S (� i2c, -CUA Heat Source: ❑Gas WElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duple ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ❑Remodel Pd Repair ❑T.I. ❑Sin ❑S rinkler ❑Demolition ❑Change of Use <br /> i <br /> DESCRIPTION OF WORK: <br /> �e' <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 # List of Fixtures # List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) I <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 1Wood 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 /> I <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 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.1 am the owner,or/am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractor Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> Owner1Au1 orized Agidt Signature Date (Revised 10/1212015) <br /> l <br /> j <br />