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0 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING I SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-881(1 I FAX 1 425-257-8857 1(E)everettepsCmeverettvva.gov J *Ww.everettwa,qovjperrntts <br /> l(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4a PROPERTY TAX M <br /> LEGAL for new construction: Short Plat,;subdlv!sion____' - <br /> Lo*No. (attach OOPY Of long legal description] <br /> OWNER NAME: CONTACT INFORMATION <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: SIREET <br /> OWNER PHONEAPTS. I-Z— OWNER EMAIL: 11 1A <br /> CONTRACTOR NAME 5 <br /> CONTRACTOR ADDRESS: <br /> C17Y S'A I L Zip <br /> CONTRACTOR PHONE: r CONTRACTOR E11111111!1111I <br /> CONTRACTOR LICENSE#(REQUIRC-[)I: <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 11 OWNER CONTRACTOR 13 OTHER(PfeaseSpecify) <br /> CONTACT NAME: <br /> CONTACT PHONE: <br /> 4R2' <br /> I=L <br /> CONTACT EMAILInam" <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Wprk: <br /> Proposed Use of V'uilding: 6—Source:­ Gas [71EIectric 0Other <br /> Building Type: 9SFR-Detacoed CISFR-Attached.............OD,jiplex CMulfi-Family-#of Units: 0Com -iorcial 01ndustrial <br /> Type of Project: ONew 'InAddition DRemodel ORepair CJT,,.I,. OSign []Sprinkler ODemolition ElChange of Use <br /> DESCRIPTION OF WORK: <br /> Rk4k <br /> -ASSOCIATED BUILD! PERMIT#(if applicable): <br /> MECHANICAL PERMIT!EPLICATION— PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn -1,/Alteration _Repair Type of Project: New Addn <br /> N of _Alteration —Repair <br /> Fixtures List of Fixtures #of List of F! of #of <br /> Fixtures xtures Fixtures List of Fixtures List of Fixtures <br /> Nc—Nit,Handlnq�Units Heat Purrp Toilet Fixtures <br /> Forced Air Systems Unit Heater Bathtub Backflow Preventer(inside Bldg) <br /> I Urinal <br /> Gas T "e <br /> Bathtub <br /> 6a List <br /> Of Fixture <br /> a 's <br /> Gas Boiler Lav2tory AAA-Inch Basin Drinking Fountain <br /> y B" <br /> Water Heater— —Refrigera,,�Jon Shower Floor Drain <br /> hS 0, <br /> _,I <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> a r <br /> Wood Stave <br /> t'ng <br /> W" <br /> Gas Range =Ducting nDishwasher Roof Drains <br /> Clothes Dryer Hookups 0 r Cl t Dishwasher <br /> Washer <br /> R�a 9 a H Other Clothes Washer Medical Gas <br /> Ran <br /> Hood W t t <br /> n e Hood Water Heater Other: <br /> x 't S k S I /B <br /> Exhaust M <br /> Clothes <br /> 'I 'pi, <br /> 't,) <br /> Sink�Service/Bar/Mnpietc) <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> ]Chemical or Water —TN,) of Heads <br /> — __J L <br /> ACKNOWLEDGEMENT I Piave reviewed(firs aWh(;arlon and confirm the information contained herein is true and correct. Work done pursuant to thispan7jt rriust Comply with <br /> current tederai,staire,and local jaw The granting Of 8 Permit only authonzes approved work and no deviations therefrom s m Deviation must first heauthorizc0in writing from the <br /> Budd ;at before being authorized under any Circumstance.1 am the owner,or I am authorized by the owner of this property <br /> to Perform the work for which application is made <br /> 11 the State Contractors Law 18 27 RCW and 296.200A WAC. <br /> (314,of Everett offiriaj iase only <br /> PERMIT# <br /> OA(-7 01 - c)6 <br /> r hor ed Signet re Date (Revised 9.121/2016) <br />