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PERMIT APPLICATION <br /> �BUILDIF MECHANICAL/ PLUMBING I SIGI�:...�.�'RINKLER I DEMOLITION <br /> '"`® —' CITY OF EVERETT PERMIT SERVIuL_ <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> RoiEbsl-Tt I ,FF. <br /> PRO EgT SITE F DR SS: PROPERTY TAX M �^� <br /> V ' ' . <br /> 402 P) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT;INFORMAT10N <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET c� - <br /> C CITY �' 4/' � I®` ATE ZIP <br /> OWNER PHONE: 4 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE Z, <br /> CONTRACTOR PHONE: TRACTOR EMAIL. <br /> � J <br /> CONTRACTOR LICENSE#(REQUIRED): =VERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMA11 RY CONTACT: ❑OWNER CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BULLDLNG'PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ ? <br /> Proposed Use of Building: Heat Source: ❑Gas ElElectric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ElDuplex OMulti-Family-#of Units: ElCommercial OIndustrial <br /> Type of Project: El New ❑Addition ❑Remodel E]Repair [IT.]. ©Sign OSprinkler ODemolition EChange of Use <br /> DESCRIPTION OF WORK: s <br /> ,�j <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHNICAL PERMIT APPLIC/1TION'' <br /> APLUMBINCy PE:RMIT.APPLICATION. <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 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 /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER fTSUPPRESSION SYSTEIM: <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 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. <br /> City of Everett Official Use Only <br /> PERMIT ffiV, <br /> Owner Authorized Agen Signature Date (Revised 1011212015) <br /> 170 <br />