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PERMIT APPLICATIOI'� <br /> BUILD�rIECHANICAL/PLUMBING/SIGN ��NKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREEf,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> L�' /� PROJECT S1'[E ENFORM�kT1�N <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> !r� d�� �'�,�1'�+� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> � �� � � COI�TA�'�'1[�(�MI�'fCON � ��� <br /> OWNER NAME: -' � � ,�a�„� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer �'/'�/f ;f�'/ � <br /> cm �E � STATE � ziP � ��'�v <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTRee-r <br /> ciTv STATE ziP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �Z� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) � ,'n /j�� <br /> CONTACT NAME: CONTACT PHONE: _�' �'r � <br /> �� ��' �� CONTACT EMAIL: � � � r ; � <br /> '; BFllLQING:�EELNC�'A���[F/k�l�t - <br /> Existing Use of Building: ,� Contract Price of Work:$��.��,• 't?� <br /> Proposed Use of Building: ,,�� ��� Heat Source: ❑Gas ,,�`Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: ✓' � ❑Commerciai ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. OSign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: �Q� �,���_.y�,��'" Ll�;r� �„� <br /> ���o �/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECItAN�GAit PEI�Ml�/4PPE.lCA�t�t�l PLUMBlNG PERM�T/�P�lt'.�l'�tGN <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn Aiteration _Repair <br /> Fixtures ��st of Fixtures Fixtures Usf of Fixtures F���� List of Fixtures Fixfu es List of Fixtures <br /> A/C—Air Ha�dling Units Heat Pump Toilet BackFlow Preventer(Inside Bidg} <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiier 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 Medicai Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRt�flEtER�S4UPPt�ESS�dI�S1�S'FEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:!have reviewed this application and confrrm the information contained herein is true and correct Work done pursuant to this permit must comply with <br /> current federal,stafe,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing f�om the <br /> Building O�cial before being authorized under any circumstance.I am fhe 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 Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM # <br /> r Q� <br /> OwnerlAuthorized Agent Signature Date (Revised 10/12/2015) <br /> / <br /> ,� <br /> �����} <br /> � <br /> Y� <br />