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PERMIT APPLICATIOI I <br /> BUILDIN�I..IIECHANICAL / PLUMBING /SIGN'� �RINKLER/ 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) PROdECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: „ <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT`INFORMATION <br /> OWNER NAME: , _ �� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESSV STREET �.�-� <br /> CITY STATE C.� ZIP / <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTReer a' � <br /> CITY ��� � STATE � ZIP <br /> CONTRACTOR PHONE: �� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENS (REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: , . � <br /> CONTACT EMAIL: - <br /> ..; ,... <br /> "<:�,� BUILDING PERMIT APPLICATION <br /> Existing Use of Building: � Contract Price of Work: $ <br /> Proposed Use of uilding: Heat Source: Gas ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition _emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOR�� � ��� � � ��4� +- ��� <br /> !(„�ti: � � I.c.J <br /> ���' �1 <br /> ASSOCIATED BUILDING PE IT#(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 Lisf 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 No.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 federal,state,and local law. The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must first be authorized in wrifing from the <br /> Building Official before being authorized under any circumsfance.1 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 compty with fhe Sfafe Confractors Law 18.27 RCW and 296.200A WAC. <br /> � City of Everett Official Use Only <br /> / PERMIT# <br /> 1�1'l �01�'a� <br /> Ow r/Auth ' ignature Date (Revised 9/23/2016) <br />