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PERMIT APPLICATION& <br />BUILDS NG / MECHANICAL / PLUMBING I SIGN I SPRY NKLER I DEil6OLffION <br />CITY OF EVERETT PERMIT SERVICES <br />m 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 />Q8lue or Black Ink Only Please) PROJECT SITE INFORI<JllATHOM <br />PROJECT SITE ADDRESS: AROO, <br />PROPERTY TAX #: ekes C 20 <br />LEGAL for new construction: Short Plat/subdivision _Lot No. (attach copy of long legal description) <br />CONTACY HIM Oir MAii l®lLll <br />OWNER NAME: Lq TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: STREET - P <br />CITY ` 0 e- { STATE U <br />OWNER PHONE: y 2 1 — <br />OWNER EMAIL: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: STREET ( a(, ,\ 7 <br />cry oe- STATE <br />CONTRACTOR PHONE: 1A — I ( <br />CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): <br />CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: <br />CONTACT PHONE: kk_2 2-_ <br />CONTACT EMAIL: <br />HILDILDINO PERMIT APPLICATION <br />Existing Use of Building: <br />Contract Price of Work: $ <br />Proposed Use of Building: <br />Heat Source: []Gas DElectric ❑Other <br />Building Type: SF -Detached ❑SFR-Attached []Duplex []Multi -Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ffNew ❑Addition ❑Remodel ❑Repair ❑T.I. []Sign ❑Sprinkler ❑Demolition []Change of Use <br />DESCRIPTION OF WORK: L` o ens i u C A-- -kA <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL "RMIT 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 />I <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Forced Air Systems <br />Unit Heater <br />, <br />Bathtub <br />Urinal <br />Gas Piping <br />Boiler <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Water Heater <br />Refrigeration <br />' <br />Shower <br />Floor Drain <br />Gas Fireplace <br />Wood Stove <br />Kitchen Sink & Disposal <br />Grease Trap <br />Gas Range <br />Ducting <br />t <br />Dishwasher <br />Roof Drains <br />P <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 />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. l 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 />ia" C <br />1l <br />Owner/Authorized Ag nt Signature <br />0 <br />Date <br />City of Everett Official Use Only <br />PERMIT# <br />�l7Z o-o6Z <br />(Revised 912312016) <br />F <br />