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............. ................ <br /> PERMIT APPLICATIO <br /> BUILDII1t4 i MECHANICAL/ PLUMBING / SIGN SPRINKLER/ 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-govi permits <br /> PROJECT SITE ADDRESS.- PROJECT SITE INFORMATION <br /> lPROPERTY TAX#: <br /> 2 <br /> LEGAL for new construction: Snort Piatirsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER=NAMEL- -LP TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS. STREET C <br /> Crry w. <br /> STATE ZIP -7 C. <br /> OWNER PHONE: <br /> i 1OWNER EMAIL: <br /> CONTRACTOR NAME: (71 <br /> CONTRACTOR ADDRESS- STREET t0cl[­k�­,`.­t <br /> CITY I <br /> C, <br /> CONTRACTOR PHONE: <br /> 1CONTRACTOR EMAIL: Q C I C <br /> CONTRACTOR LICENSE#(REQUIRED)., EN C H S'L V 1 '2 <br /> CITY OF EVERETT BUSINESS LICENSE#IREQUIREDIIJ <br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify} <br /> CONTACT NAME: CONTACT PHONE:,?C-I,- <br /> CONTACT EMAIL <br /> J <br /> C (2 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ContractPrice of Work:$ 2 <br /> Proposed Use of Building: Heat Source: 0Gas OElectric []Other <br /> Building Type: OSFR-Detached 171ISFIR-Attached ODuplex 01&16-Family-4 of Units: OCorrimercial Oindustrial <br /> TypeofProject: ONew UAddition ORemodel ORepair OT.I. 0Sign _ OSprinkler ODernolition OChangeofUse <br /> DESCRIPTION OF WORK! <br /> CA 0-- SiIiAf')CX /Ylc,k <br /> 1ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New --j(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 I Fixtures Fixtures Fixtures <br /> &1C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld2) <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 Ran2e 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 /> I lNumber of Heads IL <br /> ACKNOWLEDGEMENT i have reviewed this application and confirm the information contained herein is true and correct. 'Work done pursuant to this permit muss 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 0cial 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 lcomp the State Contractors Law 18.27 RCW and 236.200A WAC. city of Everett O!Tcia!Use Only <br /> PERMIT#� <br /> OwnerlAu0fized Agent Signature Date fRe vised 10112!2015) <br /> 61 10 <br />