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PERMIT APPLICATION• <br />BUILDING I MECHANICAL / PLUMBING / SIGN / SPRINKLER EMOLITIO <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(131425-257-8810 1 FAX 425-257-8857 1(E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />(Blue or Black Ilnk Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: tf <br />Vb . <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivisial description) <br />_.:., CONTACT INFORMATION . <br />OWNER NAME: TENANT NAME (If Commercial):% AX". <br />OWNER MAILING ADDRESS: STREET&W . <br />%i <br />V*" CITY STATE IPA • ZIP <br />OWNER PHONE: <br />OWNER EMAIL: <br />CONTRACTOR NAME; TOO. <br />CONTRACTOR ADDRESS: STREET <br />CITY STATE ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR PLOTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: 2O6 . 2L <br />__LL <br />CONTACT EMAIL: T <br />BUILDING. PERMIT APPLICA_ ON. <br />Existing Use of Building: MIdNAContract <br />Price of Work: S_ <br />Proposed Use of Building: .�% %far/ <br />Heat Source: J*as ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi -Family- # of Units: &ommercial ❑Industrial <br />Type of Project: ❑New ❑Addition 'temodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler emolition ❑Change of Use <br />DESCRIPTION OF WORK: A&94VQ 1 r " too <br />- �� �� �(.i u <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 />Shower <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.• l 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 1 comoly with the State Contractors Law 18.27 RCW and 296.200A WAG. <br />City of Everett Official Use Only <br />PERMIT # D n w—obz-. <br />(Revised 912312016) <br />�Z <br />