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Blue or Black Ink On <br />PROJECT SITE ADDRESS <br />PERMIT APPLICATION <br />BUILDIN� �ECHANICAL / PLUMBING / SIGIW� = �RINKLER / DEMOLITION <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 />Please) PROJECT SITE INFORMATION <br />2G � �UG fi S� • � �� �'C � . PROPERTY TAX #:��� �fl �'C� � � � <br />�LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) � <br />BUILDING PERMIT APPLICATION <br />Existin Use of Buildin d <br />9 9� ��� IC 4 Contract Price of Work: $ g���� <br />Proposed Use of Building: b F �CS Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: Commercial ❑Industriai <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign Sprinkler Demolition ❑Change of Use <br />DESCRIPTION OF WORK: �.y� aCc �yf 5/nt� !� U O9'C ' �' '� Z'C� � <br />iC�S�/X� �/L►.�'� �i �' i' �'/,ec.....i L�.�-- ; '� <br />2qD � `i�l b . <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixfures Fixtu es List of Fixtures <br />A/C — Air Handling Units Heat Pump <br />Forced Air Systems Unit Heater <br />Gas Piping Boiler <br />Water Heater Refrigeration <br />Gas Fireplace Wood Stove <br />Gas Range Ducting <br />Clothes Dryer Hookups Other: <br />Range Hood <br />Exhaust Fan <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixfures #°f List of Fixtures <br />Fixtures Fixfures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and cor�ect. Work done pursuant to fhis permit must comply with <br />current federal, state, and loca! 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 ci�cumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WFlC. <br />� <br />orized Agent Signature <br />_ Z� / <br />Date <br />City of Everett Official Use Only <br />PF,�MIT� �\ I��� �� JCJI <br />I r� i ) <br />(Revised 5/20/2016) � <br />� <br />