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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / 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 cir'Black llnik I�In1y Please), PRQJECT SITE IFIFO'INiAI(N„t ry mF <br />PROJECT SITE ADDRESS: A I <br />I PROPERTY TAX M <br />LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br />�: CONTACT INFORMATION - <br />OWNER NAME: TENANT NAME (If Commercial): 130es' 1, <br />OWNER MAILING ADDRESS: STREET C)/ A <br />CITY Z:-C`O1-e STATE zip <br />OWNER PHONE: UZS — Z3 ~ig(d OWNER EMAIL: <br />CONTRACTOR NAME: zP LJ2 //�� <br />CONTRACTOR ADDRESS: STREET / ,eC{ GJ <br />CITY STATE zip <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): /ZP 5e- vr' 4�-Q07 Q 7 <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): Q 3% (p S <br />PRIMARY CONTACT: WOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT N/ IIE: <br />CONTACT PHONE: C/ZS - 2_3g, <br />CONTACT EMAIL: <br />BUlLD1iNG ,PERMIT APPLICATIOhh,,,; <br />. �. , <br />Existing Use of Building: <br />Contract Price of Work: $ zs <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 />ME4 N't AL',PERMITAPPLICATIpM`. , <br />PLUMBTI G PERM APPLICATION,. <br />Type of Project: New Addn Alteration _LRepair <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 />I Grease Trap <br />Gas Range <br />Ducting <br />Dishwasher <br />I 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 />,SPRINKLE.R/ <br />SUPPRES,SI"ON SYSTEM 7 <br />Chemical or Water <br />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 <br />/Law <br />w1118..27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />/ PERMIT # AA <br />(1 <br />Owner/Authorized Agent Signature Date (Revised 912312016) (/ <br />