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PERMIT APPLICATION <br /> BUILDINaECHANICAL/ PLUMBING /SIGN/ �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� www.everettwa.gov/permits <br /> (B1ue or 61ack Ink On1y Please) PROJECT SITE INFORM�ITION <br /> PROJECT SITE ADDRESS: Z Z O� C!�L v/�J1�j,� � PROPERTY TAX#: <br /> LEGAL for new wnstruction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �� Q{.��,�'�j� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReEr d � �S 2, 2, � V�JC, <br /> - CITY STATE ZIP�, 2 <br /> O1IVNER PHONE: — � 3 Q OWNER EMAIL: <br /> CONTRACTOR NAME; O�N f ��U�_ Z� <br /> CONTRACTOR ADDRESS: s-rReeT <br /> cirv STA7E ziP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUS►NESS 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: S le Contract Price of Work:$$(�(�� <br /> Proposed Use of Buiiding: S � Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTfON OF WORK: n�_���� <br /> K� <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION` PWMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #�f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fi�ures Fixtures <br /> A/C—Air Handiing 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 /> C(othes 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 SYSTEM" <br /> Chemicai or Water No.of Heads <br /> ACKNOWLEDGEMENT.�l have reviewed this application and confirm the information contained herein is frue and correct.Work done pursuant to this permit must comply with <br /> current federai,sfate,and local law.The granting of a permit only authorizes approved work and no deviafions therefrom.Deviafions must first be authorized in writing from the <br /> Building O�cia/before being authorized under any circumstance.1 am fhe owner,or I am authorized by the owner of fhis 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 /> � ZI/!7 P IT# � �0� � <br /> Owner/Au oriz d ge t Signature ate (Revised 9/23/2096) <br />