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� I II PERMIT APPLI�N <br /> � BUIL�ING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/ � ON <br /> CITY OF EVERETT PERMIT SERVICES �}G/i�� <br /> 3200 CEDAR STREET,EVERETT,WA98201 - ��Y�1 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> PROJ CT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /j PROPERTY TAX#: <br /> 1 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> _ . _ , . <br /> OWNER NAME �./t(./ � , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-raeer � <br /> CITY (, y STATE y U ZIP C U <br /> OWNER PHONE: � � C OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: s-raeer � l �Q (� , (�/�/ ' <br /> � CITY � � STATE --�� ZIP `� <br /> CONTRACTOR PHONE: �" �' � I � CONTRACTOR EMAIL: f� � C <br /> CONTRACTOR LICENSE#(REQUIRED): � �� � ��M CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � S 2-��� � <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONT CT NA E: � CONTACT PHONE: `Z �- � , � <br /> � ����'� ��u" t (Z.- CONTACT EMAIL: <br /> BUI.LDINGi 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 /> T e of Pro'ec: ❑New DAddition ❑Remodei e air ❑T.I. �Si n ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � <br /> � l� �� ��1� � f ����:�1. c_.e,�� �(�.�.-�I--�n.L� �'�..��,.� <br /> � <br /> ASSOCIATED BUILDING PERMIT#(if ap licable): <br /> MECHAN�CAL PERM T APPLICA,TION PWMBING PERMIT APPLICATION <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 #of List of Fixtures <br /> Fixtures Fixtures Fixtures Flxtures <br /> A!C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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: Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 7 SUPPRESSION SYSTEM <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 compry with <br /> current federal,state,and local law.The granting of a permit onty authorizes approved work and no deviations therefrom.Deviations must first be auihorized in writing from the <br /> Building Official before being authorized under any clrcumstance.!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 Stafe Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � PER T <br /> U2. � a � / 1 � �«�Z ` �S <br /> Owner/Author' d Agent Signat e Date (Revised 10/i2/2015) <br />