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PERMIT APPLICATION , <br /> BUILDIN9ii1IECHANICAL/ PLUMBING /SIGN (Ji INKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJEC E ADDRESS: PROPERTY TAX#: <br /> N-j A-v <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 'o 'VI TENANT NAME(If Commercial): �O C A' Y <br /> OWNER MAILING ADDRESS: STREET 1 1 VLVR A (1-1�-V p //� (1 <br /> CITY STATE (-�•Y' ZIP 6Q\1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: -A1o(4 1c} <br /> CONTRACTOR ADDRESS: sTREET6 S` -`1I Ci� r„ <br /> CITY U IR N STATE �T ZIP `(�(� <br /> CONTRACTOR PHONE: " _ --2-7 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED)�,{� (J - C --t t" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: El13.1 OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ^ <br /> ��?� eLw✓ CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: []New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> IVIG . h z QVtivox4- s <br /> ASSOCIATED BUILDING PERMIT#(if applicable): LP U — L <br /> MECHANICAL PERMIT APPLICATION PLUMBING 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 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/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:/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 1 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# <br /> Owner/Authorizgd Age ure Date (Revised 10/12/2015) <br />