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PERMIT APPLICATION <br /> BUILD14MECHANICAL I PLUMBING I SIGN&RINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> -0J4 <br /> PROJECT SITE ADDRESS: j0,17 <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short PJaYsubdivision_Lot No. (attach copy of long legal description) <br /> '- 1A1170 <br /> a <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: S/0- 3?-4.4'JOWNER EMAIL: C, <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET STATE ZIP <br /> CITY V'-e/. <br /> CONTRACTOR PHONE: 1/'ZS • 3,23 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): t--P" R?("'r( CITY OF EVERETT BUSINESSLICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER OCONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ZI2S. 2-75 '2,23 <br /> e- ",7 <br /> <J CONTACT EMAIL: Ll- vl <br /> ............. <br /> VE IT.". 4-Jq—_X <br /> T116. <br /> Existing Use of Building: lContract Price of Work: <br /> Proposed Use of Building: Heat Source: QGas ElElectric ElOther <br /> Building Type: EISFR-Detached EISFR-Attached []Duplex E]Multi-Family-#of Units: MCommercial Elindustrial <br /> Type of Project: EINew MAdditiQn []Remodel []Repair EIT.I. E]Sign ElSprinkler F-IDemolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> C'41 4-- <br /> JASSOCIATED BUILDING PERMIT#(if applicable): <br /> ;:'MECHANICAL PERMIT <br /> A'P.PL1:Q..(TION::_.` <br /> Type of Project: —New Addn __Alteration —Repair Type of Project: _New Addn —Alteration _Repair <br /> #of #of List of Fixtures #of List of Fixtures #Of List of Fixtures <br /> Fixtures List of Fixtures Fixtures Teat—Pump Fixtures Toilet Fixtures Backflow Preventer(inside Bldg) <br /> -Fic-Air—Handring units <br /> Forced Air Systems Unit Heater 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 /> P <br /> y P <br /> UPPIR X. <br /> N . ..$ 00f <br /> lNumber of Heads <br /> ACKNOWLEDGEMENT.,lhave 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors L 18.27RCWand 296.200A WAC. City of Everett Official Use Only <br /> "'Lvv <br /> //�/- <br /> with <br /> PERMIT <br /> f0 r <br /> I 91ho <br /> Ovvner/Au4thorizet signature Date (Re'vised 101'1212015) <br />