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PERMIT APPLICATIor <br /> BUILDIR VIECHANICAL/ PLUMBING /SIGN i , RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> E{� 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> P OJ CT SITE ADDRESS: PROPERTY TAX#: <br /> I� F <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION. <br /> OWNER NAME: 3 k Q akE TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> ZIP ; <br /> clTv ru Q iiSTATE <br /> i� <br /> OWNER PHONE: L �'VLJ OWNER EMAIL: <br /> CONTRACTOR NAME: T �— <br /> CONTRACTOR ADDRESS: STREET <br /> `�� CITY STATE\,Q� ZIP <br /> CONTRACTOR PHONE: ` � �� CONTRACTOR EMAIL: ',I ' <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C <br /> PRIMARY CONTACT: 40WNER [X CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> V CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION :.:. <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel []Repair I]T.I. []Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: ��) �1t.+�+^ 1::1•��� a^ �''��� �-CC 3 �'�rGa�S' �1 1``� <br /> 061--N- (00 G(tC X,,&-62-ate COO I��.k x r"v" �p 4®• <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project:•*A_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 lShower 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:"rcv,W <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) 2, Other:,— L;G^i�_C;%'t <br /> SPRINKLER/SUPPRESSION SYSTEM'. <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•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.I am the owner, or 1 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 /> wn It —ized Agent Signature Date (Revised 101121201 5) <br />