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0 PERMIT APPLICATIONO <br /> BUILDING I 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJPCT SITEINFORM�i'TION <br /> : <br /> PR JCSIDE ADD ES . _ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . ; . • ` ,CONTACT,IN,FORMATIOM <br /> OWNER NAME: J� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CI-n, STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 1 e <br /> CONTRACTOR ADDRESS: STREET Q f,412 <br /> CITY -rp��jry STATE ZIP <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ieE z J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ®-OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> PiCg CONTACT EMAIL: <br /> BU.ILD�NG'PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-DetacheR-Attached ❑Duplex EMulti-Family-#of Units: [JCommercial ❑Industrial <br /> Type of Project: E]New ElAddition EIRemodel ORepair EIT.I. I]Sign bSprinkler ElDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: � IQ� �T�Q f 11V(A -Te-) <br /> 4,rteNEyJ S rr�7�v �c r LET,- S Not��2 <br /> �4r�A Sr�vx. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> T LfCATI <br /> MECHANICAL PERMIT APPLICATION:' <br /> PLUMBING PERMI .APP ON. <br /> Type of Project _New Addn Alteration _Repair Type of Project _New _Addn _Alteration _.Repair <br /> #of #of List of Fixtures #Of <br /> List of Fixtures <br /> List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump / Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater j Bathtub - Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain- <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPP_RESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.,1 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 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Con 7:w 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> --- PERMIT# <br /> er/Authorized Agent Signature D91e (Revised 10/1212015) <br />