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PERMIT APPLICATIO <br /> BUILDINP MECHANICAL/ PLUMBING / SIGN_PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E 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 /> 1110. ECT SIY.E INFORMATION. <br /> PROJE T SITE ADDRESS: PROPERTY TAX#: Z OG;G' C C) <br /> Z---> Z lA l 5- tet/ / ,7r <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> -c :CONTACT INFORMATION - <br /> OWNER NAME: e5 c/'d f�/` /3°111 LW-L','/-Z,7/Yb4ANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2:_7 <br /> crry CTT STATE ZIP <br /> OWNER PHONE: >�=? 'j���'/ �G OWNER EMAIL: Y°x ( l'r� SPS ✓' *! t �M <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> _,. , <br /> BUILDING. PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: oe— Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project:&New ❑Addition ❑Remodel ❑Repair ❑TJ. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: C olj/ 7t ufZ /(P'— I LgAj6r <br /> 11-4ml w /oof 6 . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL-PERMIT APPLICATION,; <br /> P <br /> LUMBLN:G PERMIT APPLICATION;`.' <br /> Type of Protect: New _ Addn Alteration _Rep ' Type of Project: _New _Addn _Alteration —Repair <br /> #of List of Fixtures #of List of Fi res <br /> List of Fixtures #of • t of Fixtures #of <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Pr nter(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drin rig Fountain <br /> Water Heater Refrigeration Shower F ar Drain <br /> Gas Fireplace Wood Stove lKitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting IDishwasher Roof Drains <br /> Clothes I Hookups Other: Clothes Washer Medical Gas <br /> Ra Hood Water Heater Other: <br /> haust Fan Sink(Service/Bar/Mlip/etc.) Other: <br /> SPRINKLER SUPPRESSION SYSTEM: <br /> Number 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 aut p,orized under any circumstance./am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and]comply with the State Cont tors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> I' PERMIT# <br /> Owner/Authorize ge t S nature Date (Revised 10/12/2015) y <br /> 1� <br />