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PERMIT APPLICATION <br /> BUILDIf , ' MECHANICAL/ PLUMBING /SIG" ' :)PRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERA. <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION:. <br /> PROJECT SITE ADDRESS: � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT" INFORMATION! <br /> OWNER NAME: T�L, TENANT NAME(If Commercial): s W01M ti(i <br /> OWNER MAILING ADDRESS: STREET g W <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: n <br /> CONTRACTOR NAME, uo 5t D-)3 JD <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): UJ`a7�Z <br /> PRIMARY CONTACT: O OWNER O CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ •L <br /> Proposed Use of Building: AA Heat Source: []Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached []Duplex OMulti-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: El New ❑Addition ORemodel ORepair OT.I. ❑Sign OSprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: l <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMITAPPLICATION P..LUMBING PERMIT 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 A Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater N 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/SUPPRESSLON SYSTEM. <br /> Number of Heads <br /> ACKNOWLEDGEMENT:1 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 Oficial before bein honed under any circumstance.t 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 Statronlrarors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorized Agent Si nature Date (Revised 10/12/2015) <br />