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�V PERMIT APPLICATIO1111 <br />BUILD <br />ING 1 ECHANICAL / PLUMBING / SIGN -JRINKLER / 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 Ink Only Please) PROJECT SITE INFORMATION <br />PROPERTY TAX #: r <br />3ROJECT SITE ADDRESS: <br />_EGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />DWNER NAME: <br />OWNER MAILING ADDRESS-' STREET <br />CITY <br />OWNER PHONE: 701(c Z�ZD <br />CONTRACTOR NAME: j 41 <br />CONTRACTOR ADDRESS: <br />CITY <br />CONTRACTOR PHONE: / �LO L <br />CONTRACTOR LICENSE #(REQUIR <br />PRIMARY CONTACT: ❑ OWNER <br />CONTACT NAME: <br />&,t'l <br />L <br />CONTACT INFORMATION <br />TENANT NAME (If Comme <br />7 L ON-�-1 <br />STATE <br />OWNER EMAIL: (' p A �1 ,--e Y <br />STATE <br />CONTRACTOR EMAIL: 1 ' Gt l <br />CITY OF EVERETT BUSINESS LICENSE <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: _ _S"`z} (( S <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Z'P �r <br />Yir �& "C <br />S. <br />191 <br />Existing Use of Building: Contract Price of Work: $ 4 `' <br />Proposed Use of Building: <br />Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famii 4 of Units: <br />ommerciai []Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ]Sprinkler • ❑Demolition ❑Changeof Use <br />K: <br />DESCRIPTION OF WORT _ S L <br />oaf `' it. -gut, .� o"itX�77f` <br />wa �. Q,ss 4 Ili <br />ASSOCIATED BUILDING PERMIT # if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New 4ddn ,_Alteration _Repair <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 />Forced Air Systems <br />Unit Heater <br />Gas Piping <br />Boiler <br />Water Heater <br />Refrigeration <br />Gas Fireplace <br />Wood Stove <br />Gas Range <br />Ducting <br />Clothes Dryer Hookups <br />Other: <br />Range Hood <br />Exhaust Fan <br />SPRINKLER <br />/ SUPPRESSION <br />SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn Alteration _Repair <br /># o <br />Fixtures <br />List of Fixtures <br />To[ <br /># of <br />Fixtures <br />List of Fixtures., <br />Backflow Prev(Inside Bldg)_ <br />Bathtub <br />Urinal <br />Lavatory (Wa asin) <br />ing Fountain <br />Shower <br />Floor Drain <br />Kitchen Sink & Disposal <br />Grease Trap <br />Dishwasher <br />Roof Drains <br />Clothes Washer <br />Medical Gas <br />Water Heat <br />her: <br />Sink ( ice/Bar/Mop/etc.) <br />Oth <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. worK cone pursuarri ru uua ii—1 - ., u�• . 11plr •1 <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 'th the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br />Owner/Authorized Agent Signature Date (Revised 912312016) <br />