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PERMIT APPLICATION ;� ORIG1NAt
<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 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: ����� �' /+� PROPERTY TAX#: ,� (�
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<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTReer �
<br /> CITY STATE ZIP
<br /> OWNER PHONE: Z "� Q^' OWNER EMAIL: �
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<br /> CONTRACTOR NAME; 'U �
<br /> CONTRACTOR ADDRESS: STREET �
<br /> CIN STATE -- ZIP
<br /> CONTRACTOR PHONE: � ` �� CONTRACTOR EMAIL: `
<br /> CONTRACTOR LICENSE#(REQUIRED): ��/ � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
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<br /> PRIMARY CONTACT: ❑OWNER [�CONTRACTOR ❑OTHER(Please Specify)
<br /> CO TACT NAM : CONTACT PHONE: — l —
<br /> ��J6� {��,� e � CONTACT EMAIL: ` �/
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<br />, Existing Use of Building: � Contract Price of Wor . �
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric �Other
<br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Mu�ti-Family-#of Units: ❑Comme ial ❑Industrial
<br /> T e of Pro'ect: ❑New �Addition ❑Remodel Re air ❑T.I. ❑Si n ❑Sprinkler ❑Demolition han e of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ,;.,� , ' ,§MECHANICAL„PER�lill�',APPLICA?IQN, ..,. �� . , a.,;� t, , .�PLUM�ING�PERMIT,��`APPLIC%ATION�� �; ,5 .,:,3:
<br /> Type of Project: _New Addn Alteration Repair Type of Project: _New Addn Alteration _Repair
<br /> #of �ist of Fixtures #of List of Fi�ctures #°f Lfst of Fixtures #�f Llst of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handlin 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 Dr er Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink Service/Bar/Mo /etc.) Other:
<br /> ,�SPRINKLER,/,�Si�Pf�1�ESS1'ON SXS�EM,�.,, �;'
<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 compty with
<br /> current federal,state,and local law.The granting of a permit only authorizes approved work�nd 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 this property to perform the work for which application is made,
<br /> d I comply with the tate Contractor Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> �� PERMIT� � � D � � ���
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<br /> t Sfgnat e Date (Revised 10/12/20i5)
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