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PERNIIT APPLICATION <br /> BUIL.DWC IECHANICAL/ PLUMBING / SIGN 'RINKLER/ DEIVIOLITION <br /> CITY OF EVERETT PERMIT SERVIC�� <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 /> PRO ECT SITE ADDRESS: PROPERTY TAX#: <br /> _ �+- c , rr� ��> .t; �' i: c c. r - � <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � �,:; r ��'-LS �" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT �-j'5:::` �j`����5 ,,_.p�.:j� � ' <br /> � CITY j�� �j���'=� STATE ,'�'--- ZIP ����v,; � <br /> OWNER PHONE: 'j 7 ,��; j OWNER EMAIL: <br /> CONTRACTOR NAME: �;c�-, 9 v�•�,ffYV/}� �1iZi,�, i._�_ <br /> CONTRACTOR ADDRESS: sTReeT �' ��, y �' �; �;'1.� <br /> CITY /���(.��'%' �� STATE {,�"�,-- ZIP ��j�_t� <br /> CONTRACTOR PHONE: ��,O(.. �1!r �1 j CONTRACTOR EMAIL: ,�. �y � �' � ._,., <br /> CONTRACTOR LICENSE#(REQUIRED): �}�L'�,9��vc:'�[j�4� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER f;�'CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: � CONTACT PHONE: � `�� � � � �_��7 <br /> �' /� t��' k� ., `,.� --,,� CONTACT EMAIL: �-- r�.- � <br /> � �n, 61. ��. � ,���3�"1'1 :�'���,i w.'!� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: '��t �yr�,"�'` Contract Price of Work: $ � :� c:;� c <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached Duplex �Multi-Family-#of Units:�� ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel I�Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �"r,��- /��p ��!�/� i ,�, ,•}.�,fi' �-'�cr'F=' ��-r- �- � �! <br /> � ` �Cv k' _ �,-1` L fJ1 /�'�T- 4.c��' <br /> �CCC� y�`(R.�,r�rK fU�%"_u.s��'�i, ��f7,'_'�T,Ti�c:•�L�ce�-r ti�; �_ �,P6e <br /> ^ � r <br /> �; l <br /> ASSOCIATED BUILDING PE M�#(if applicab e):r��� �r��t,'��L ������� �����`�� ����/ ���t �`'���� )����L <br /> MECHANICAL PERMIT l�PPL.ICATlOI�I PLUM�ING PERMIT !�lPPI.IC/4TIOR1 <br /> ___ ._ _ _-�`�.�___...... <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixfures #°f Lisf of Fixtures <br /> Fixfures Fixtures Fixtures Fixfures <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 /> ACKNOWLEDGEMENT:l have reviewed this applicatron and confimr 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 /> Bui/ding Official before being authorized under any circumstance.1 am the owner, or I am authorized by the owner of this properfy to perform fhe work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> /' 1 % City of Everett Official Use Only <br /> A � PERMI # <br /> � (�. <br /> G j��ti, � � � �. J '�� <br /> �� <br /> Owner/Authorized Agent 5ignature Date (Revised /12/2095) <br />