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PERMIT APPLICATION I',I
<br /> BUILDWG / MECHANICAL/ PLUMBING /SIGN / SFRTNKLER/ 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.govlpermits
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<br /> PROJECT SITE ADDRESS: � �4��s �j PROPERTY TAX#: �� �
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTReer �� C P/j�y"'
<br /> CIN STATE ZIP ��
<br /> OWNER PHONE: �-ZCj�n2 � OWNER EMAIL:
<br /> CONTRACTOR NAME: �/�/'j"� j� m � � '
<br /> CONTRACTOR ADDRESS: srReeT I3 �� •
<br /> CITY �V��� STATE � ZIP ����
<br /> CONTRACTOR PHONE: �L������lp CONTRACTOR EMAIL: ,�/�XA'K�� �}�lJ�/�g , �
<br /> CONTRACTOR LICENSE#(REQUIRED): J,A /�fff�" �1�L� CITY OF EVERETT BUSINESS LICENSE#(REQUIR ):�f Q�
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ���-���L�
<br /> ��A�" �� �f-� CONTACT EMAIL: ��(/,/�.�,V � �� .�� ��
<br /> ����' � „ ' :' "�`'�`��B @ Cs���RN��'T�APPLICATION . �` � -".� � ���`�`
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<br /> Existing Use of Building: Contract Price of Work:$ (ol ��D
<br /> Proposed Use of Building: Heat Source: v�IGas Electric Other
<br /> Buildin Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerciai ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ��P�C� �r�15T��G' �T�S �/?in/.��� �.0 l7�" �'��� Cr�� �I?�I(Jfl-G�+�
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> IVIECHANICAL PERMIT.APPLICATIO,N�� _a=, ` PWMBING;PERMIT APPLICA`�;ION,r:_,.. . ..:.,'� ,
<br /> Type of Project: New _ Addn Alteration Repair Type of Project: New Addn _Alteration _Repair
<br /> #of List of Fixtures #�f List of Fixtures #°f List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixfures Fixfures Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg)
<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�SYS7`EM��,���
<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 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.Deviations must first be authorized in 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 with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> t�' 1 � PE����� _ � l.J
<br /> Owner/ thorized Agent Signa re Dat (Revised 9/23/2016)
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