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PERMIT APPLICATION <br /> BUILDING CHANICAL / PLUMBING /SIGN / S -IKLER/ DEMOLITION <br /> CITY OF EVEf'RETT PERMIT SERVICES' <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �jr'j� PROPERTY TAX M <br /> LEGAL for new construction: Short Piaf.'subdwislon —Lot No.— (attach copy of long legal description) <br /> CWTACT INFORMATION <br /> OWNER NAME: L R TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 2 <br /> riry Q <br /> c� STAT= <br /> OWNER PHONE: Z� l t(f'i OWNER EMAIL: <br /> CONTRACTOR NAME <br /> CONTRACTOR ADDRESS: sTRr er <br /> CITYSTATE �,' ,L <br /> "("`[ ZIP <br /> CONTRACTOR PHONE:` > , _ (� CONTRACTOR EMAIL: �'' �` <br /> / � a���°t� C��ALL r.�--rz ��.��: >tir-,, <br /> CONTRACTOR LICENSE#(REQUIRE>0): (� '� 7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):) <br /> PRIMARY CONTACT: ❑OWNER iCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: _ %x SQ <br /> CONTACT EMAIL:Y <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building, Contract Price of Work:$ q 5700 <br /> Proposed Use of Building- Heat Source: . Gas ❑Electric ❑Other <br /> Building Type: JWSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New Addition ❑Remodel ❑Repair ❑T.I. ❑Sin ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1�T1ace <br /> ASSOCIATED BUILDING PERMIT#(if applicable <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn AAlterat€on _Repair Type of Project: New Addn _Alteration _Repair <br /> #of List of Fixtures #of #of <br /> Fixtures List of Fixtures List of #°f <br /> FList of Fixtures <br /> ixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet <br /> Forced Air Systems Unit Heater Bathtub 6aekflow Preventer(Inside Bldg)Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen SinkDispos 1 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(SienccelBar/Mo letc.) tither. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> 16 <br /> ICKNOWLEDGEMENT:t have reviewed this application and confirm the informafien contained herein is true and correct. Work done pursuant to this permit must comply with <br /> urrent 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 /> iudding 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 /> not I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official use only <br /> RM <br /> PE <br /> t= 7`, - ► _fig - <br /> Iwtn rlAuthorized Agent Signature Date <br /> (Revised 9/2,7/2G16) <br />