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PERMIT APPLICATION <br /> BUILDINC ECHANICAL / PLUMBING / SIGN 'RINKLER / 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 /> PROJECT SITE ADDRESS:�,Z 3o '{� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision — —Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: t(� Vl S i✓✓� TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET Q�J-e/Z3�0a Ge) `� <br /> CITY C ✓ '- STATE ZI_P <br /> OWNER PHONE: 9 37�� OWNER EMAIL: L! �p �✓t — St,� 1/P✓ 'L"iitd[ ®/rld� t t>L <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STA I E. ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> {`otv�G S 14/r CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: I Heat Source: ❑Gas PElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached fi2lDuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition EiRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION 1'WORK: <br /> vl \ <br /> )0 {-.�� �-°I 5 � t pr -5 �f��� al,std// R-°Ung-e for- l e�r1" <br /> lVA"� <br /> ASSOCIAT D 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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Sy ms 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.I 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. 1 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# <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) , ( O v� <br /> L.�l <br />