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I PERMIT APPLICATION <br /> BUILDING 1 I�CHANICAL/PLUMBING /SIGN/��1KLER/ 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 Blaak Ink`On1y,Please) PROJECT SITE 1NFORMATION <br /> PROJECT SITE ADDRESS: � � • 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: sTReer <br /> CITY " STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: sTReeT <br /> ciTr srn� zia <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 /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 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: <br /> �\� �1 Vl� �' � Sf2� � 6 .�� <br /> �� `� Y � <br /> �� � <br /> ASSOCIATED dU1LDING rERMIT�(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 usf of Fixfures #of Lisf of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures �xfures <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(Vl/ash 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:3 <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/;SUPPRESSION SY$TEM' <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the information contained herein is true and correcf.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 O�cial before being authorfzed under any circumstance.I am the owner,or!am authorized by fhe owner of this property to pe�form the work for which application is made, <br /> and I comply with the Sfate Contracfors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Onty <br /> � ^ � � PERMIT# ��oZ f�� <br /> ! �{ <br /> Owner/Authoriz Agent Signature ate (Revised 9/23/2016) <br />