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PERMIT APPLICATION <br /> BUIL* / MECHANICAL/ PLUMBING /SIGMVPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SER\71W <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT:SITE:::jNFQRMAT 0114:­­.. . <br /> PROS TSITE JD RES1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> TACT'll IN <br /> OWNER NAME: (6' TENANT NAME(if Commercial): vi VA, Yl DnA 16� <br /> OWNER MAILING ADDRESS: STREET I ST <br /> cn-y & STATE �,IC) zip <br /> OWNER PHONE: 1OWNER EMAIL: <br /> CONTRACTOR AME: yl <br /> CONTRACTOR ADDRESS:..'_ JSTREET 11>7 140CL Sr 2- <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: <br /> 1CONTRACTOR EMAIL:OACA]2� <br /> J <br /> CONTRACTOR LICENSE#(REQUIRED): ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,-;, b e4,?- ;2-0 <br /> CONTACT EMAIL: <br /> -BUILDIN9VERMIT4 .. <br /> APPLICATION. <br /> Existing Use of Building: Contract Price of Work: <br /> Proposed Use of Building: lHeat Source: E]Gas DElectric 0Other <br /> Building Type: EISFR-Detached EISFR-Attached 0Duplex OMulti-Family-#of Units: OCommercial ElInclustrial <br /> Type of Project: []New OAddition EIRemodel EIRepair EIT.I. OSign OSprinkler OlDernolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> rum <br /> JASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,;MECHANICAL PERMIT APPLICATION:' ;; PLO StI40P90MITAPPLICATION <br /> Type of Project. —New Addn —Alteration _Repair Type of Project: _New —Addri —Alteration ­Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #Of List of Fixtures <br /> Fixtures 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 /> RangeHoodWater Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER <br /> .00S. 110114M' <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 authorized under any circumstance.I am the owner,or am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> PERMIT# <br /> (Revised 1011212015) <br /> Own 1 A,—Vt-grued nt Sj—&ature Dare <br />