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• PERMIT APPLICATION* <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: q I � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal descri <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I ( S y ( ) <br /> CITY -7 - r STATE �;'v ZIP <br /> OWNER PHONE: L-f - t� OWNER EMAIL: <br /> CONTRACTOR NAME: (� <br /> CONTRACTOR ADDRESS: 1 STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: V� ( -� t " CONTRACTOR EMAIL: t/\ b/ , <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �-2 <br /> PRIMARY CONTACT: WNER ❑CONTRACTOR ❑ OTHER(Please Specify) <br /> CONT CT NAME: CONTACT PHONE: - -7V ,P <br /> r—a kVA <br /> U _ CONTACT EMAIL: y �. 45 I) L <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: I Contract Price of Work: <br /> Proposed Use of Building: Heat Source: AGas iloElectricthey <br /> Building Type: WR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: ommercial El Industrial <br /> Type of Project: ❑New ❑Addition El Remodel []Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> L� IV� C� �w <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 /> 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 /> Number of Heads <br /> ACKNOWLEDGEMENT.'1 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.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> q <br /> Owner/Authorize rl6nt Signatu Date (Revised 1011212015) <br />