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PERMIT APPLICATION <br /> BUILDINI IECHANICAL /PLUMBING /SIGNIlr= �RINKLER/ DEMOLITION <br /> CITY OF EVER�TT PERMIT SERVIC�S <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: r PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � ��� ' C �� TENANT NAME(If Commercial): — <br /> OWNER MAILING ADDRESS: srReeT <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTReeT 3 T <br /> CITY d STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: J' ' ____�--_� <br /> CONTRACTOR LICENSE#(REQUIRED):�J � (3 (� � 3�����CITY OF EVERETT BUSINESS LICENSE#(REQUIRE�j: .� - <br /> PRIMARY CONTACT: ❑OWNER f�CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �� ,- 2'�-� � 1 �� <br /> �� �(, � � CONTACT EMAIL: ��v �j ����-( -e Gl�,�� <br /> � BUILDING PERMIT APPLICATION ------ <br /> c� Cj <br /> Existing Use of Building: Contract Price of ork: $ ' �UUd " � <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric L7Other <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 ❑Chan e of Use <br /> DESCRIPTION OF WORK: ���,1,���� ' � p 4� �e " P �.{ � d v '�'�l � C� �,�j�; ti r U�' C:P> ; `1 u LL9 ,r� <br /> �� ��-�i�� �s ;�:� y ��1� ��� � <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL. PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration Repair 7ype of Project: New Addn Alteration Repair <br /> #of Lisf of Fixtures #of List of Fixtures #of Lisf of Fixtures #of List of Fiactures <br /> Fixtures Fixtures 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 Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Ciothes Dryer Hookups Other: Ciothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is irue and correct. Work done pursuant to this permit must comply with <br /> cur�ent federal,state,and local law. The granting of a permit only autho�izes 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> � City of Eve�ett O�cial Use Only <br /> f �� ` � =� � ;` PER T# r <br /> '�L.� � � \�� �� � <br /> Ow" uth �ized Agent Signa ate (Revised 9/23/2016) <br />