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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING I SIGN / SPRINKLER / 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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: is 1- <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: y� ,4,� j TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET '5—/ AV.Q <br />CITY STATE LA JCf ZIP <br />OWNER PHONE: Sal <br />OWNER EMAIL: <br />CONTRACTOR NAME, v ` t- 1 <br />CONTRACTOR ADDRESS: STREET / v.(2 v b <br />'' nn <br />CITY -� ( �j� STATE W ZIP <br />CONTRACTOR PHONE: 02b& Z g <br />I CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): rL3Ai- � ( 1 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): C> j` Z) <br />PRIMARY CONTACT: ❑ OWNER W CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: ` ciA e— ZC'W i K,4 <br />CONTACT PHONE:CU> (--1 <br />CONTACT EMAIL: ,�4W L l 1 <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Wog : $ 00 "— <br />Proposed Use of Building: <br />Heat Source: ❑Gas . ❑Electric ❑Other <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 ❑Change of Use <br />DESCRIPTION OF WORK: <br />ASSOCIATED BUILDING PERMIT # (if applicable): `— <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _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 />IShower <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/Bar/Mop/etc.) <br />Other: <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Chemical or Water <br />I <br />I No. of Heads <br />ACKNOWLEDGEMENT. I 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />(Revised 912312016) <br />