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PERMIT APPLICATIO. BUILDIN©ECHANICAL / PLUMBING / SIGN IRINKLER/ DEMOLITION CITY OF EVERETT PERMIT SERVICES OL 3200 CEDAR STREET, EVERETT,WA 98201 (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits (Blue or Black Ink Only Please) PROJECT SITE INFORMATION PROJECT SITE ADDRESS: `` j �� PROPERTY TAX#: LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) CONTACT INFORMATION OWNER NAME: jTENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET S u2 Al ////// CITY STATE (/L/k ZIP OWNER PHONE: OWNER EMAIL: CONTRACTOR NAME: e CONTRACTOR ADDRESS: STREET �� CITY ,t��h � STATE Z& ZIP �C� CONTRACTOR PHONE: Ej/ S- - - CONTRACTOR EMAIL: ��G,-ce.�/�,�._-{ (� ffpj . (` CONTRACTOR LICENSE#(REQUIRED): Gln e e fl C,1 0 GZ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): SI SS PRIMARY CONTACT: ❑ OWNER 187CONTRACTOR ❑ OTHER(Please Specify) CONTACT NAME: CONTACT PHONE: c 7 61t'e'r/v�1 CONTACT EMAIL: BUILDING PERMIT APPLICATION Existing Use of Building: ,, r.e— Contract Price of Work: $ 5 Proposed Use of Building: Heat Source: ❑Gas EElectric ❑Other Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial Type of Project: El New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition []Change of Use DESCRIPTION OF WORK: .Cxt7'LI ��Y�einee�e� otle S/Q r :f' ASSOCIATED BUILDING PERMIT#(if applicable): MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater Bathtub Urinal Gas Piping Boiler / Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: SPRINKLER/ SUPPRESSION SYSTEM Number of Heads ACKNOWLEDGEMENT./have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with 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 Building Official before being authorized under any circumstance. 1 am the owner,or am authorized by the owner of this property to perform the work for which application is made, and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only i/ PERMIT# Ow r/Authorize gent Signature Date (Revised 5/20/2016)