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� <br />� <br />� <br />PERMII' APPLICATION <br />BUILDIIVG / ME�4ANIGAL / PLUMBING / SIGN / SPF2�LEFt / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />OJECT SITE ADDRESS: pry� ��� PROPERTY TAX #: oQ � � R� �� <br />lb/ <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />BUILDING PERMIT APPLICATION <br />ting Use of Building: Contract Price of Work: $ �-fs. � <br />roposed Use of Building: Heat Source: lp9t�as ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: �Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: R���E �,�S�nl G� �f� H�j � (�(f �r� T%�L (�I �-�hF� �/�) <br />�a-�s � f,c��-; �rc-`� i �„v � � S�� ���N J n1 c> ,�J�% <br />�-s P�Q�� <br />ASSOCIATED BUILDING PERMIT # (if applicabl� <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn �Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of Lisf of Fixtures #�f List of Fixtures #�f Lisf of Fixtures #°f List of Fixtures <br />Fixtures Fixfures Fixfures Fixtures <br />A/C —Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) <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 />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />OWLEDGEMENT: 1 have reviewed tliis application and confirm the information contained herein is true and correct. Work done pursuant to this permif must cornply wifh <br />nt federal, state, and local law. The granting of a permit only authorizes approved worl< and no deviations theref�om. Deviations must first be autl�orized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work for which applicatron is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />�P" / '(,l ((c��3- D-Z � <br />Owncr orized Agent Signature Date (Revised 90/12/2015) <br />