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PERMIT APPLICATI�i.
<br /> BUILDIN��•uIIECHANICAL/ PLUMBING /SIGI�-�UPRINKLER/ 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 /> BI��Q�Bla��#���� P�� �e ��?��T��TE.M�����'�� :
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<br /> PROJECT SITE ADDRESS: ���iJ ��i�-�,(„� �'� PROPERTY TAX#:
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: 'L� ��-- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReer ��� � " (� �1
<br /> CITY �� � STATE �3� � �ZIP �(�G�4.� I
<br /> OWNER PHONE: +1=a��� OWNER EMAIL:
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<br /> CONTRACTOR NAME: ��1 �,/� ,(�C y� ��C�1 S
<br /> CONTRACTOR ADDRESS: sTReeT r"C> � p�� ��1c�
<br /> CITY �,,�-{���(_„(,� STATE f;�� ZIP �`���
<br /> CONTRACTOR PHONE: ��Q(j• (�"�� - �� CONTRACTOR EMAIL: I� �� �� + "� ' . CJ
<br /> CONTRACTOR LICENSE#(REQUIRED): {�C� C�s� ��~� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ���
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<br /> PRIMARY CONTACT. ❑OWNER �.CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ���Q ,(�,� , ���`�,`
<br /> �;� CONTACT EMAIL: �� ��� G - �� �� `` i ,
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<br /> Existing Use of Building: Contract Price of Work: $ ��
<br /> Proposed Use of Building: Heat Source: �Gas ❑Electric ❑Other
<br /> Buildin Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> T pe of Project: ❑New ❑Addition ❑Remodel �(Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Type of Project: New _ Addn _Alteration Repair Type of Project: New Addn _Alteration Repair
<br /> #of List of Fixtures #�f List of Fixtures #of List of Fixtures #°f List 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 Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
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<br /> SPR�Nl�LEIi./°SU,P,,PRE�SI4N S�fSTE�VI, '
<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 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�cia/before being authorized under any circumstance.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> `� ,:.,, City of Everett Official Use Only
<br /> �� r i� i���� _ PERMIT#
<br /> -�" ` �p �� � � r;,,� �(p(O �' D oZ�7
<br /> Own r/Authorized Agent Signature ate (Revised 9/23/2016)
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