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PERMIT APPLICATI®r� <br />BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blase ®r Black Ink OnRy Please) PROJECT SITE ➢NF®RMATI®N <br />PROJECT SITE ADDRESS: ( 6 -4 C ,c ,eve <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No. (attach copy of long legal descri tion <br />CONTACT ➢NFORMATI®N <br />n <br />OWNER NAME: <br />TENANT NAME (If Commerci I): <br />OWNER MAILINGADDRESS: STREET 4C <br />,r O <br />CITY Ve <br />STATE > ZIP <f-Ls ate, <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET Q <br />o <br />CITY vet hS'W <br />STATE L-A/'k ZIP 40UG <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: L_ r L4 <br />CONTRACTOR LICENSE #(REQUIRED): jc—('t-(Se <br />CITY OF EVERETT BUSINESS LICENSE #(RE IRED). ' <br />PRIMARY CONTACT: ❑ OWNER 9 CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />��- <br />CONTACT PHONE: 1-f <br />CONTACT EMAIL: L f—k4 N <br />BUILDING PERMIT APPLICA <br />Existing Use of Building: <br />Contract Pr' a of Work: <br />Proposed Use of Building: <br />Heat Source. ❑Gas jgElectric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi -Family-# of Uni <br />Type of Project: ❑New DAddition ❑Remodel ❑Repair <br />❑T.I. ❑Sign []Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: t <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: X New _ Addn _Alteration _Repair <br />Type of Project: _New Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />A/C —Air Handling Units <br />Heat Pump <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />Roof Drains <br />Clothes Dryer Hookups <br />Other: <br />Clothes Washer <br />Medical Gas <br />Range Hood <br />Water Heater <br />Other: <br />Exhaust Fan <br />Sink (Service/BarlMop/etc.) <br />Other: <br />SPRINKLER I SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />No. of Heads <br />ACKNOWLEDGEMENT. l 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 I am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PER <br />11 C) — 00 <br />(Revised 912312016) <br />i <br />