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� PERMIT APPLICATIOI�
<br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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� yvww.everettwa.govlpermits
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<br /> (Blue or Black ink Oniy Please) ; .;<; „ PROJECT S,I,TE INFORMATION '
<br />� PROJECT SITE ADDRESS: � �Gk%� t PROPERTY TAX#: �
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (aftach copy of long legal description)
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<br /> CONTACT INFORMATION,�`;, :
<br /> OWNER NAME: TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srReer
<br /> � �� f ��CITY c�jQ�Y�U/f/� STATE �/(/ ZIP � /D
<br /> OWNER PHONE: (p—Pj� �7`7 OWNER EMAIL: j0 �j`71 � ,�y�� • f fsy
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<br /> CONTRACTOR NAME; !C�ij c�L 6�v
<br /> CONTRACTOR ADDRESS: sTRee-r
<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 /> i BUILDING PERNI,IT:APPLICA'�'ION :
<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 /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demo'' n ❑Change of Use
<br /> DESCRIPTION OF WORK: ,ePj�9-e� /��C1S /'�C L/�- �( litJ/ T/� ��U---
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable: C� �D� ��� �
<br /> IVIECHANICAL,PERMIT APPLICATION; PLUMBING PERMIT APPLICATION ' `
<br /> Type of Project: _New_ Addn Alferation _Repair Type of Project: _New _Addn Alteration _Repair
<br /> #of List of Fixtures #of List of Fixfures #of List of Fi�ures #of List of Fixfures
<br /> Fixttrres Fi�cfures Fixtures Fixtures
<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 itchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting ' washer Roof Drains
<br /> Clothes Dryer Hooicups Other: • Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/BadMop/etc.) Other:
<br /> SPRINF�L�R/'SUPPRESSION SYSTEM _
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•I have reviewed this application and confrrm the informafion contained herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must frrst be authorized in writing f�om the
<br /> Building Official before being authorized under any circumstance.l am the owner,or l am authorized by the owner of this propertyto perform the work for which application is made, �
<br /> and!comply with the State Contractors Law 98.27 RCW and 296.200A WAC.
<br /> Cify of Everett O�cial Use Only
<br /> PER T#
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<br /> Owner Authorized Agent S�gnature Date (Revised 5/20/2016)
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