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�ERI�9T AP�L9CA�"106� <br /> ��BL.DIPi1G I i�l�Ct�9ARlICe�L/ P�IJ�$�IN�i I�1C,�i�l I����Y�9�'a�..Ef�/ ���Ola��'IOi� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 �(E)everetteps@evere#twa.gov� www.everettwa.gov/permits <br /> ��Be�e�¢��I�ek S����6y�9�ase) P�����`��9`H"E 9dd�'�R9�iAT10� <br /> PROJECT SITE ADDRESS: ��) • �L�� �'`��,1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legai description) <br /> �ON`�'AC'd' ITA�ORMA"�&ON <br /> OWNER NAME: TENAPVT NAME(If Commerciai): <br /> OWNER MAILING ADDRESS: sTReEr <br /> � ��7y ' STATE � ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �'('j,���� <br /> CONTRACTOR ADDRESS: sTReET <br /> GTY STATE ZIP _ <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAI�: <br /> BUILDING PERMIT APPLICATIQP! <br /> Existing Use of Buiiding: Contract Price of Work:$ �� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industriai <br /> Type of Project: ❑New ClAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �.�� � �o� I��r �-#� e� . �� . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL.PERMIT APPLIC�4TION PLUMBING PERMIT APPl.ICAYION <br /> Type of Project: ,_New_ Addn _Alterafion _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of Lisf of Fixtures #�f List of Fixtures #of List of Fixfures #of Lisf of Fixtures <br /> Fixfures Fi�ctures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Sysfems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Ciothes Dryer Hookups 1 Other. �';�#�� Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRIIe1KLER/St1E�PRESS10Ad SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�!have reviewed this application and confirm the information contained herein is true and correcf.Work done pursuant to this permit must comply wifh <br /> current federal,stafe,and local law. The granting of a permit only authorizes approved work and no deviations fherefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am fhe owner,or l am authorized by the owner of this properiy to perform the work for whrch application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> ' PE IT <br /> i ���'� �f��/�� - <br /> O er/Aufhorize ��gent Signafure Date (Revised 9/23/2016) <br /> �rn���c� — 02 Z <br />