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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRI�ER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201 G /�{�/,
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.�v/p�frtiR�L
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<br /> PROJECT SITE ADDRESS: ^ � � � PROPERTY TAX#: � � � �
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTaeeT UL � y I
<br /> � � CITY STATE � ZIP
<br /> OWNER PHONE: � " OWNER EMAIL: �
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<br /> CONTRACTOR NAME; 1����
<br /> CONTRACTOR ADDRESS: STREET"� ' �/l�
<br /> CITY STATE �V ZIP
<br /> CONTRACTOR PHONE: ` •� ' CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED , ��� � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):�Zi�:
<br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify)
<br /> C N ACT NAME: _ CONTACT PHONE: ' � � �
<br /> � ��� �� CONTACT EMAIL: �,�,(�
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<br /> ����a��. :� �� ,,. . . �aBUIi,DING�PERMIT APPLICA�I��N��—����� _ �� =`� '
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<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use of Buildin : Heat Source: Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached u lex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> T e of Pro'ect: ❑New ddition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED.BUILDING PERMIT# if a licable :
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<br /> Type of Project: _New Addn teration _Repatr Type of P 'ect: New Addn _Alter ion _Repair
<br /> #of u�of Fixtures #�f List of FTxtures #of uy�of ures #of Llst of Fixtures
<br /> Fixtures Fixtures Fixtures Fi�ures
<br /> AIC—Air Handling Units Heat Pump Toilet ackflow Preventer(Inside Bld )
<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 ar/Mop/etc. her:
<br /> ��-,.��'�S�RINs}�.aE��SUPPRE3SION,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 pe it musi compty wfth
<br /> current federal,state,and/ocal law.The granting of a permit onty authorizes approved work and no deviations therefrom.Deviations must first be authorize h writing from the
<br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply wfth tde State Contractors Law 18.27 RCW and 296.200.4 WAC.
<br /> City of Everett Officia/Use On/y
<br /> P RMT#
<br /> -1 t '-1 �2-C�
<br /> Owner/Aut gent Signa ur Date (Revised i0/12/2015)
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