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PERMIT APPLICATIC: <br /> BUILDIN MECHANICAL / PLUMBING / SIGrt SPRINKLER / DEMOLITION <br /> 4.77 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 wwv.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7o -, Noth P1,- PROPERTY TAX#: zo 67e5'0U6i <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ci Ew 1/4v LvIt\ TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET 70'7, <br /> CITY . 11 STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: �r�}�\ <br /> CONTRACTOR NAME OWA.ec <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 ❑ CONTRACTOR BOTHER (Please Specify) , 1 ) ? <br /> CONTACT NAME: _ CONTACT PHONE: 41-�s , z_ , <br /> ciactiNIACONTACT EMAIL: cp, —�Q 1(1L <br /> BUILDING PERMIT APPLICATION ��� <br /> Existing Use of Building: egff`�AC Contract Price of Work: $–_��_' �.�!) <br /> _ -- <br /> Proposed Use of Building: Jctu) Heat Source: ❑Gas IbkiE/lectric ❑Other <br /> Building Type: [ SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New DAddition ❑Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition Fange of Use <br /> DESCRIPTION OF WORK: 141( <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 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 d Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting f Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: ( Clothes Washer Medical Gas <br /> ( Range Hood Other <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER / SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:t 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 lam 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 /> 400 <br /> :2 206 PERMIT#7'1 Ilk <br /> Owner/ uthorized Agent Signature Date (Revised 5/20/2016) --� <br />