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PERMIT APPLICATIO <br /> BUILDINOMECHANICAL/ PLUMBING /SIG PRINKLER/ 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 /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:U�✓ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C CONTACT INFORMATION <br /> OWNER NAME: q S�l�.l� TENANT NAME AA <br /> Commercial): <br /> � <br /> OWNER MAILING ADDRESS: STREET � Q �� lil lJ� CC <br /> CITY C��(J�Qf STATE � .q ZIP O <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET Box, <br /> CITY Y\ I'Y e► STATE UJ-A ZIP <br /> CONTRACTOR PHONE: ` X5 3 (� S9 CONTRACTOR EMAIL: l da ( r yk f Q c6 <br /> CONTRACTOR LICENSE#(REQUIRED): (coW). �C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): , 10, <br /> PRIMARY CONTACT: ❑ OWNER VCONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONES $" <br /> I)CA C)�� 1'lel�, l V4 CONTACT EMAIL: QS 11 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: 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: I t f - O k ji � A� g i �� G� <br /> )V� (/(cam r/v+' ` <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: ,_New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures I 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.) ter: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 /> I 6 <br /> In n n^ � 13 <br /> 1 / j (' PER IT O <br /> Owner/Authorized Agent Signature Date (Revised 10/1212015) <br /> �J✓, m <br />