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PERMIT APPLICATION <br /> BUILDINC-1ECHANICAL / PLUMBING / SIGN—PRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVr <br /> OL 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 ITE ADDRESS: PROPERTY TAX#: <br /> U I,'r r- i 0, 1 "1 <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET NC6 t- <br /> CITY 1-' STATE 40{('G H ZIP <br /> OWNER PHONE: 60 OWNER EMAIL:, (, Vick-ad <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sTREEr <br /> CITY Q STATE ZipP c„ <br /> 760 7 <br /> CONTRACTOR PHONE:Sp J CONTRACTOR EMAIL: a {(^st,— r C , t`Cj,r,l <br /> CONTRACTOR LICENSE#(REQUIRED): Q, C_ C- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):!;r <br /> PRIMARY CONTACT: ❑OWNER M CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 0 <br /> 3 319 �Jlii <br /> 1 I 1( CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ,v V"osl< Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: was ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 19Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Sign []Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: _ Ie-'ICIX4 1_ <br /> br-A,0 r•�i i y s Co pfr< &v�J j vt5rc.t,( S r-c, buc;kS <br /> ASSOCIATED BUILDING PERMIT# if applicable): <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 lRefrigeration 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:1 have reviewed this app/icafion 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# 1;� (an-3 <br /> �SjgAnatur <br /> CJ �J` I Ver/Authorized Agent Date (Revised 10/12/2015) <br />