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PERMIT APPLICATIO <br /> BUILDIN�IECHANICAL/ PLUMBING /StGN�INKLER/ 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� vwvw.everettwa.gov/permits <br /> (Blue`or Black Ink On1y Please) PRAJECT SITE INFORMATIOIof <br /> PROJECT SITE ADDRESS: 2��� l,X)�� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> kOWNER NAME: ..� �,�C.� �'}� TENANT NAME(If Commercial): ��-P L„ ,$ <br /> OWNER MAILING ADDRESS: srReEr ( -�Ci� � — <br /> CITY �� STATE (/`��! ' ZIP % � <br /> OWNER PHONE: � �--�" ���"'�`�c U OWNER EMAIL: � �"61� p, J e L <br /> � CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: sTReer <br /> CITY 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 EMAIL: <br /> BUILDING PERMiTAPPLICATION <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-Famil -#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: y��� ���� ^ �� �,�. ]�� � �\ n��r � SU� <br /> .���� � <br /> ���� � w <br /> ASSOCIATED BUILDING PERMIT#(if a plicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Atteration _Repair <br /> #of Lisf of Fixfures #�f List of Fixtures #of List of Fixfures #�f List of Fixtures <br /> Fixfures Fixtures Fixtures F" ure <br /> A/C—Air Handling 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: <br /> SPRINKLER/SUPPRESSION SY$TEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information confained herein is true and correct.Work done pursuanf to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must frrsf be aufhorized in writing from the <br /> Building O�cial before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply e State Confractors Law 18.27 RCW and 296.200A WAC. <br /> � City of Everett Official Use Only <br /> ,� PERMIT �Q �� <br /> � �-`� �' <br /> Owner/Aut r ed Agent Signature Date (Revised 9/23/2096) <br />