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PERMIT APPLICATION <br /> BUILDI�rIECHANtCAL/PLUMBING/SIGN / �NKLER/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@evereriwa.gov� www.evereriwa.gov/permits <br /> L ° � PR4JECT SITE tNFORMATION <br /> PRO��T SITE ADDRESS: � PROPERTY TAX#: ,,,�r� ���,,,�� <br /> L�`l <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> GONTACT tNFORMATlON <br /> OWNER NAME: � �' � .�,�;a j TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT �j't�/,� �,$'j � <br /> CITY �� � r STATE ,�e ZIP 9 ���+ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTReer <br /> CITY . STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �. /�I�D <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify)M �-����f' � ` , <br /> CONTACT NAME: CONTACT PHONE: r <br /> _� °1' ^� ' <br /> �� �'�. � �� CONTACT EMAIL: � � � P , � <br /> - <br /> B�lILDtN�'a PEI���EkPPt[G/k�tQl�t <br /> Existing Use of Building: � Contract Price of Work:$ �3 <br /> Proposed Use of Building: ,1�,f� ��� Heat Source: ❑Gas �E`lectric ❑Other <br /> Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition �Remodel epair ❑T.i. OSign ❑Sprinkler ODemolition ❑Change of Use <br /> DESCRIPTION OF WORK: �- ��������' C,J�� �gyyt <br /> L// � <br /> ASSOCIATED BUILDlNG PERMIT# if applicable): <br /> ,MECItANtCA!PEE�Mf'E A�P�,�C�''Et�?N ;: P�UMBtNG PERMtT�4PPLLCI.4'�fil[r1 <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixfures #of Lisf of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixfures 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) Drinkin 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 /> SPRI�IKLER f SUPPi�E5S10[�t�1�5'�EM <br /> �,_.. <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•!have reviewed this application and confirm the informaUon contained herein is true and correct Work done pursuant to fhis permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviaSons therefrom.Deviations must first be authorized in writing from the <br /> Building Offrcial before being authorized under any circumstance.1 am tire owner,or l am authorized by the owner of this property to perform the work for which applicaGon is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Oificia!Use Only <br /> PERMIT�� r �^ I ��� <br /> ir� �j <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> / �l� � <br /> ! � r°� <br /> �, ` .�` <br /> "�....�...�`. <br />