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PERMIT APPLICATI�j <br /> BUILD� MECHANICAL/ PLUMBING/SIGIa'7 �PRINF�CLER/ 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 Black Ink On1y Please)_ PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � (�q. 113� � S � �W-Pl' PROPERTY TAX#: tJ�S 7 3 tpDU�O ,3[pd � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �1 j�, ��-C� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rReer p � � � S� <S <br /> CITY �,Q�-� STATE �� ZIP (.6 �C.� <br /> OWNER PHONE: �a.�.�-3�1-S�j�� OWNER EMAIL: <br /> CONTRACTOR NAME; W��2� <br /> CONTRACTOR ADDRESS: sTReEr <br /> CIIY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETi'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: $1SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodei epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTIOM OF WORK• � ,��;1 ��� ��,��� � d C��� ��� <br /> �y1��cL`�t LJet�-ls �. GP.t �i� �'�- � i �`"'� <br /> t^�g�u� t� �f� �..�°`'L.( i"� rh r t� �('t�a rv� � �..��-�--n -� e��+� �'�� rc�Drr� <br /> �+�Sfa.0 i�.i�tz,��. c.ti.�. � d��P�s�. �. d �s k�a s�.e_..-', r�a�-c� �ra r.�� ►.oaA <br /> ce.ee�.r- a. o�t�.� �Fa+. ti.nb1�:.�.es <br /> ASSOCIATED BUILDING PERMIT# if a licable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> #of Lisf of Fixtures #�f List of Fixtures #of (,�st of Fixtures #°f List of Fixtures <br /> Fixfures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen SinK&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> ' Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> a Exhaust Fan Sink(Service/BadMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SY$TEM: <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuanf to this permit must comply with <br /> current iederal,state,and locaf law.The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must firsf be authorized in writing from the <br /> Building O�cial before being aufhorized under any circumstance.1 am the owner,or l am authorized by the owner of this property to perform fhe work for which application is made, <br /> and 1 comply wifh the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> Cify of Evereft Official Use Only <br /> `�� �'�1�,���J ��`7 / �� PERMIT#�� V l � O�/ ' <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2096) <br />