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PERMIT APPLICATIOI� <br /> BUILD� MECHANICAL/PLUMBING/SIGN��INKLER/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.gov/permits <br /> r� � � � PRE3JEG'[Sr�TE INFORI�FATL�1�1 <br /> PRO��T SITE ADDRESS:, PROPERTY TAX#: ,,,r�^� ���/,�� <br /> C./`/" <br /> LEGAL for new construction: Short Plabsubdivision Lot No. (attach copy of long legal description) <br /> GONTACT tNFORMATION <br /> OWNER NAME: � " � .�+�`� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT j/'�;� ��f9'j � <br /> cirv �°� s-ra-rE � ziP � ��� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: srReer <br /> CITY 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)� �'��� <br /> CONTACT NAME: CONTACT PHONE: �' �'� ""�' <br /> �� �� � �� CONTACT EMAIL: � � � � y y� <br /> , , �_ . <br /> � � � '` °BCiE��13EME;��ERM#T APR�.IEA'���3[�E� _ � - � <br /> ;, ME� � � � "-���r-..; <br /> f <br /> Existing Use of Building: � ��P Contract Price of Work:$ <br /> Proposed Use of Buiiding: ,�,�� ��� Heat Source: ❑Gas �Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached �Duplex ulti-Family-#of Units: �� ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel epair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � �;����;��' �� �� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> = MEEH'AN1C/kE PERN�¢PPE�L����l� ' , RLtIMBlN�'a L�ERN{�T�f!����'�T[4�F'. <br /> Type of Project: _New Addn Aiteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of Lisf of Fixtures #of tist oiFixtwes #of List of Fixtures <br /> Fixfures 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 /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: • <br /> SPR��1lFLER�S�JPPI�ES51t�!`�STEM� ' <br /> Number of Heads <br /> ACKNOWLEDGEMENT.-!have reviewed this application and confirm the information contained herein is irue and correct.Work done pursuant to tiris 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 wNting from the <br /> Buifding Official before being authorized under any circumstance.1 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 tire State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everetf O�cia!Use Only <br /> PERMIT <br /> � ... <br /> Owner/Authorized Agent Signature Date (Revised 10/?2/20?5) <br /> �� ,a�, <br /> �� <br /> ___.__--' <br />