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PERMIT APPLICATION <br /> BUILDING ECHANICAL I PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVI <br /> 3200 CEDAR STREET,EVERETT,WA001 <br /> (P)425-257-8810 1- FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettvva.gov/permits <br /> PROJECT SITE ADDRESS: <br /> 1PROPERTY TAX# (f) ci CM r <br /> LEGAL for new construction: Short Plat/subdivision X Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATIO <br /> OWNER NAME: TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 102 S- 5R ft,7 1) Sz <br /> CITY &EV65-7 I STATE ZIP <br /> OWNER PHONE: V i Olkirl_u <br /> OWNER EMA I L: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ICITY OF EVERETT BUSINESS LICENSE*(REQUIRED): <br /> PRIMARY CONTACT: DOWNER EICONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDINGPERMITAPPLICATION <br /> Existing Use of Building: lContract Price of Work:$ <br /> Proposed Use of Building: I Heat Source: []Gas ElElectric []Other <br /> Building Type: EISFR-Detached EISFR-Attached E]Duplex []Multi-Family-#of Units: ElCommercial ElIndustrial <br /> Type of Project: E]New ElAddition E]Remodel EIRepair EIT.I. E]Sign []Sprinkler ElDemolitiori []Change of Use , <br /> DESCRIPTION OF WORK: pzvv� ;UVA Iq C� d o"n 11 <br /> uia,� S-N-, <br /> JASSOCIATED BUILDING PERMIT#(if applicable): <br /> � .MECHANICAL'0tkMAPPLICATION:,h ` . PLUMBING' Pt Milt <br /> APPLICATION, <br /> Type of Project: _New _ Addn -Alteration ___Repair Type of Project: _New _Repair <br /> #of List of Fixtures #Of List of Fixtures of List of Fixtures #of List of Fixtures <br /> Fixtures I Fixtures Fixtures 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 I., UPPRESSION.'.S ST14M. <br /> lNumber ofHeads <br /> ACKNOWLEDGEMENT.,I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this pen-nit 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> I C Nc� PERMIT t���, ") I L'O I (� V) � —M I <br /> Owner/Authorized Agent Signature Vbate `� " (Revised 1011212015) <br />