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PERMIT APPLICATION <br /> BUILDING'IP J MECHANICAL/ PLUMBING ,SIGN /SPRINKLER, DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: viz. CoUV kl PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET vi-is y pi, <br /> ^ CITY '( VV STATE \1�NA ZIP 9$701 <br /> OWNER PHONE: LkJ4) ,4j-, 0111 OWNER EMAIL: Cc j je,' 31:16, C <br /> CONTRACTOR NAME: MND <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: `OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: —Ai— Heat Source: ❑Gas DElectric DOther <br /> Building Type: ❑SFR-Detached -VSFR Attacld ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. ❑Sign DSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: P r_`\ _ •,�! ,1•1Ce - Uvll GYCM Z. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): a,1-70 -00-7 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New XAddn Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler 2 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.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water 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 Contractor Law 18.27 RCW and 296.200A WAC. <br /> ', Citytyof Everettve` Official UseUs(Only <br /> Ailgighilirri, •e�',• PERMITp( OD C� — 0( 9 <br /> g �t� �� <br /> ner/Authorized .•nt Signature � ate (Revised 9/23/2016 <br />