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• PERI�(IIY 6�PPLICATION • <br /> �IJILDING / nIIECHANIC�.L/ PLUPl/iBING /SI(�R9 / SPRIiVKL.ER/ DEtVIOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or �lacfc Ink Only Ple�se) PR�JEC'i' SI'TE OI�FORMl�'rlOtd <br /> PROJECT SITE ADDRESS: ,�� � � �f � O PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTAGT INFORMATION <br /> OWNER NAME: � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT . C" <br /> CITY STATE /� ZIP ���D <br /> OWNER PHONE: �f� ��� � OWNER EMAIL: � <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTREET <br /> CfiY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ` ��, ��� '. �� <br /> ,� U � , �j CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building:Q �/1� �/ � `'f'}/��6� ' Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other <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 ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /)� ���� ��GTSt� �1/�l.( �����C�� <br /> /C <br /> c� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APP�ICATION PLUMBING PERMIT APPLICI�TION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisi of Fixtures #�f List of Fi�ctures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixiures 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 No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the informatron 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 musf first be authorized in writing from fhe <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to pertorm 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 /> PER <br /> �' � ��v� L') `� -- �.J � O <br /> Owner/Authorized Agent Signa re Date (Revised 9/23/2 16) <br />