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� PERMIT APPLICATIOt. <br /> BUILDi�t� � MECHANICAL/ PLUMBIIVG /SIGN /SPRINKLER/ DEMOLITION <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 Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �pa p PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> � <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReEr <br /> CITY v � STATE �� ZIP � ,� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; �e �� ` �� �, <br /> CONTRACTOR ADDRESS: sTREET � O �' <br /> CITY � STATE � ZIP � �O � <br /> ��_�_.>.a..,� <br /> CONTRACTOR PHONE: � 5 � ��CONTRACTOR EMAIL: 1�Q �Y' �,� <br /> CONTRACTOR LICENSE#(REQUIR D):��L��j'pfa CITY OF EVERETT BUSINESS LICENSE#(REQUIR :��j u�� <br /> PRIMARY CONTACT: ❑ OWNER OTHER(Please Specify) `" � <br /> CONTACT NAME: CONTACT PHONE• ? �3I�� <br /> � (fY CONTACT EMAIL: � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of W rk:$ <br /> Proposed Use of Building: Heat Source: ❑Gas Electr c er <br /> Building Type: FR-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: ��m��S f'f �XI,S 7'/ �-� �''`I� (�1,5 �- <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 /> ��f List of Fixtures #of List of Fixtures #�f List of Fixtures #of List of Fixtures <br /> Fi�ctures Fixtures Fixfures Fiarfures <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 frue and correct. Work done pursuant to this permit must comply with <br /> current federal, state,and local law. The granting of a permif 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 fl�is property to perform the work for wl�ich application is made, <br /> and!comply with the State Contractors Lav✓18.27 RCW and 296.200A WAC. <br /> Cify of Everett Official Use Only <br /> � ��� �� �� PERMIT�� � <br /> � i " 1 <br /> l � � �� �� <br /> Owner/Authorized Ayent Signature Date (Revise ' /20/2016) ^ ' <br /> � '(% <br />