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0 PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> OL (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 /> : <br /> PROJECT SITE ADDRESS: c�) �' U T:�2 5 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY r' STATE zip <br /> OWNER PHONE: q 2-5- c1© Y — V OWNER EMAIL: <br /> CONTRACTOR NAME: U r <br /> CONTRACTOR ADDRESS: STREET Z /= <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 2 j c 6 O CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): l l6L qs CITY OF EVERETT BUSINESS LICENSE#(REQU D <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:6zm� <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION' <br /> Existing Use of Building: Contract Price of ork:$ <br /> Proposed Use of Building: Heat Source: ❑Ga _O Electric ❑Other = <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remod.,el^ ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Dernoli�tion ❑Change of Use <br /> DESCRIPTION O WORK: Gam�f `�H( / 14-1k li`k <br /> ASSOCIATED BUILDI G PERMIT fif 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 /> Chemical or Water I I 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. 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/am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use_Only <br /> P'9 IT# �� — <br /> Owner/Authorized Agent Signature Defte �/l1 (/' (Revised 9/23/2016) <br />