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. PERMIT APPLICATIO4 <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER I DEMOI_ffION <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 oar Slack Onk Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: i "' p� �D F77(,��yr <br />17V Atoll /jtl i <br />PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision <br />Lot No._ (attach copy of long legal description) <br />CONTACT lMF®13VifATOON <br />OWNER NAME: P <br />TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET I q10o <br />& Jf r- <br />CITY <br />STATE t✓(V. <br />zipq1qj ® 3 <br />OWNER PHONE: <br />1 <br />OWNER EMAIL: <br />, _ <br />CONTRACTOR NAME: I r' <br />CONTRACTOR ADDRESS: STREET <br />CITY <br />STATE <br />ZIP <br />CONTRACTOR PHONE: <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE (REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: VKOWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />_ <br />CONTACT NAME: <br />CONTACT PHONE: a Q — <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: J( <br />Contract Price of Work: $ <br />Proposed Use of Bui ing: <br />I Heat Source: []Gas Electric <br />❑Other <br />Building Type: SFR-Detached ❑SFR- ttached []Duplex ❑Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition FfRernodel ❑Repair <br />❑T.I. ❑Sign []Sprinkler ❑Demolition <br />❑Change of Use <br />DESCRIPTION OF WORK: 1 <br />(onvei'f eXr�hro� �6vi!dIn� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />1� o qq <br />MECHANICAL PERMIT APPLICATION <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn Alteration _Repair <br />Type of Project: _New _Addn <br />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 />' <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: herinlin- <br />SPRINKLER <br />/ SUPPRESS110H <br />SYSTEM <br />Chemical or Water <br />No. of Heads <br />ACKNOWLEDGEMENT: 1 have reviewed this application and c firm 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; my authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building 0 ial before bei 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 comylY witltYthe St; cCon4ctors Law 18.27 RC and 296.200A WAC. <br />Agent Sig <br />City of Everett Official Use Only <br />PERMIT #,� <br />(Revised 912312016) <br />31 <br />