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0 0 <br /> 4ErrPERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROS�T SITE ADD. E$$: Ef Ail PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f _ } T)nNANT NAME(If Commercial): <br /> OWNER <br /> /MAILING• DDRESS: STREET /0�2, 4S -A":r(j �� q/'" �7" 1/,i/! CITY U�'t—( STATE 0 ZIP <br /> OWNER PHONE: '2'33 . 1Jj' OWNER EMAIL: <br /> CONTRACTOR NAME: 0\A21 <br /> CONTRACTOR ADDRESS: STREET `..551 1'‘e <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:k.C2WNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> i <br /> CONTACT N;11 ./ CONTACT PHONE: 12�-', 2,33 - Z-4 , <br /> r CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION r <br /> &.�,Existing Use of Building: ) A Contract Price of Work:$ <br /> Proposed Useof B ilding: Heat Source: ❑Gas lectric ❑Other <br /> Building Type/SFR-Detached ❑SFR-Attacheduplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use <br /> DESCRIPTIONWO'1 <br /> I' <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 #°f 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.: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 -de. 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 /> Buildi .Officia 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 I c•mply th the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 3 PERfT#i^('-' OS <br /> Owner/Au rent Si <br /> 9 9 �orize. • n Date (RevisednU1110/92/2010) <br />