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PERMIT APPLICA.TI%1 <br /> BUILD / MECHANICAL/ PLUMPING,%SIGF° PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> OL (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blase or Black Ink Only Please I - PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 0 r W PROPERTY TAX#: <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Com/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET t/v <br /> ZCITY STATE ZIP <br /> OWNER PHONE: Z�- 7�� "(C 2— OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET /} <br /> CRY \ 114/6"U STATE ZIP (J (T <br /> CONTRACTOR PHONE: A _ 0 6'd CONTRACTOR EMAIL: ice; t oo c, i j - <br /> CONTRACTOR LICENSE#(REQUIRED): 2 ! 7 CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): O�-y <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �Z�_ "7 <br /> CONTACT EMAIL: LJ�i'f 2 S i ��• �- <br /> BUILDING PERMIT APPLICATI <br /> Existing Use of Building: Contract Price o Work:$ b `"J <br /> Proposed Use of Building: Heat Source: ❑Gas 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. ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: - /. <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 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 /> Chemical or Water I I No. of Heads <br /> ACKNOW1 EDGEMENT.l 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.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law la 27 296.200A WAC <br /> City of Everett Official Use Only <br /> / IT <br /> G ( 3 r-03 —C)n co <br /> Owner/Authorized Agent Signature Pate (Revised 9),23/2016) <br /> 11/ <br />