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• <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER l DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES4err ` <br /> 3200 CEDAR STREET,EVERETT,WA 98241 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everettwa.gov( www,everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJIECT S1TE INFORMATION <br /> PROJECT SITE ADDRESS: 9 4 "' PROPERTY TAX#: ;` f r ��Od `a-) <br /> LEGAL for new construction: Short Plat/subdivision Lot No, (attach copy of Tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STR9Er t { <br /> �. <br /> CITY e�F� � STATE 1,J�;, ZIP <br /> OWNER PHONE: ( (!� _ C ..4 '3 > i OWNER EMAIL: <br /> CONTRACTOR NAME, 61—Y-Y \(kV^} �- <br /> CONTRACTOR ADDRESS: STREETfqq /� <br /> CITY ✓ -'` ' STATE 'tib f'""r.. ZIP a -k <br /> CONTRACTOR PHONE: tt t a { 4 "C <br /> `"4 �� '�L ""�- •--' CONTRACTOR EMAIL: c.a) <br /> CONTRACTOR LICENSE#(REQUIRED): ,i I AJ C, CITY OF EVERETT BUSINESS UCENSEIF{ UiR <br /> PRIMARY CONTACT: ❑OWNER "�1CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE; <br /> CONTACT EMAIL: t , P t r F` ..V'? t 1 <br /> BUILD111410;PERMiT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Neat Source: ❑Gas ❑ ectric ❑othlti'r <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 ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New __ Addn 4Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of #of #of #of <br /> Fixtures List of Fixtures Ffxtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> A/C—Air HandlingUnits Heat Pump Toilet Backflow Prevanter(Inside Bld <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes Drver 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 No.of Heads <br /> ACKNOWLEDGEMENT.l 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. Tho granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Oficial before being authorized under any circumstance,t am the owner,or t 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. <br /> City of Everett Official Use Only <br /> �. J #IM <br /> Owned utharized Agent Sig atu e D e (Revised 9/23/2016) <br />