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f a <br />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 or Black.lnk On1y.P..lease) PROJECT.SITE INFORMATION <br />PROJECT SITE ADDRESS: * <br />1 <br />PROPERTY TAX M t�Q�f /l�►j7 <br />.�q^^VI <br />LEGAL for new construction: Short Plat/subdivision •4%�HGf/ Lot No. (attach copy of long legal description) <br />:..;CONTACT INFORMATION...,, <br />OWNER NAME: TENANT NAME (if Commercial): <br />OWNER MAILING ADDRESS: STREET <br />CITY lr/Y �jlw STATE • ZIP wow <br />OWNER PHONE: .0007 <br />OWNED EMAIL: <br />CONTRACTOR NAME: o . <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 P&OTHER (Please Specify) <br />CONTACT NAME: <br />/ <br />CONTACT PHONE: Zob • 45ZZ <br />CONTACT EMAIL: •�' <br />BUILDING'`PERMIT <br />APPLICA,, ON'�' �: <br />Existing Use of Building: / <br />Contract Price of Work: $ <br />Heat Source: )(Gas ❑Electric ❑Other <br />Proposed Use of Building: 40Z <br />Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex []Multi -Family-# of Units: Acommercial ❑Industrial <br />Type of Project: ❑New ❑Addition Xemodel ❑Repair ❑T.I. []Sign ❑Sprinkler ,_pemolition ❑Change of Use <br />DESCRIPTION OF WORK: — — — - - L' l <br />0,1,6 ate, tI 81 146111 ;ft <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHAt�IICAL PERMIT,APPt.ICATION :. <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 />Ust 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 I SUPP,ttES$ION $YSTE.M; . <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 Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent Signature <br />City of Everett Official Use Only <br />PERMIT # I 0011 <br />Dat (Revised 912312016) <br />1 �/ <br />