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PERMIT APPLICATIONA,. <br /> OL BUILDIN IECHANICAL / PLUMBING / SIGN /-3-FRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT.WA 96201 <br /> i <br /> 425-2,57-88 ID I FAX 425-257-3857 1 lE)everetteps-beverethva <br /> (Blue or Black Ink Only Please -- 9ov I .witia.evererteva yov';rermit4 <br /> ) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ,. 1 t �Q h � PROPERTY TAX#: <br /> LEGAL c��-s+�ucton S n ,PIaI iJud Viso') <br /> -- _� Lot No. (attacY�cop,; ¢lr�ag if iescririUon; <br /> CONTACT INFORMATION <br /> OWNER NAME: <br /> TENANT NAME(If Commercial) <br /> OWNER MAILING ADDRESS: <br /> (J <br /> OWNER PHONE: Li <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET !� <br /> cirv :tyq <br /> STATEt4A ziP <br /> CONTRACTOR PHONE: t f ,`, � tti=✓�s , t� <br /> �. CONTRACTOR EMAIL: j 1 - ff 11 'CMt'Y21 �Gi [ r�r e .• ; <br /> CONTRACTOR LICENSE#(REQUIRED): 7cL I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: ' p p <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Buitcling, Contract Price of Work: $ t') O <br /> 'roposed Use of Building Heat Source as ❑Electric ❑Other <br /> 3uildin Tp,e I WFIR-29tached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Units ❑Commercial ❑Industrial <br /> `yae of Project: ❑New ❑Addition ❑Remodel ❑Rapair ❑T.1. ❑Sign OSpnnkler ❑Demolition ❑Change of Use <br /> )ESCRIPTION OF WORK: <br /> 1SSOCIATED BUILDING PERMIT#Iif applicable) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: _New _ Addn :Alteration _Repair Type of Project: New Addn Alteration <br /> of — — _Repair <br /> List of Fixtures #of #of #of <br /> mixtures Fixtures List of Fixtures List of Fixtures List of Fixtu <br /> AIC–Air Handling Unres <br /> Fixtures Fixtures <br /> its Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> EGas <br /> Air Systems Unit Heater Bathtub Urinal <br /> ing Boiier Lavato Wash Basin <br /> eater Lavatory( ) Drinking Fountain <br /> Refrigeration Shower Floor Drain <br /> eplace Wood Stove Kitchen Sink&Disposal Crease Trap <br /> nge Ductin 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 l$OPPRESSION SYSTEM <br /> plumber of Heads <br /> :KNOWLEDGEMENT:(have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this peand must comply with <br /> irrant 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 /> jitding Official before being authorized under any circumstance I am the owner cr 1 am authorized by the owner of this property to perform the work for which application is made. <br /> id t comply wilt,the State Contractors Law 18 27 RCW and 2S6 20GA WAC <br /> City of Everett Official Use only <br /> PERMIT#1 <br /> E a <br /> nrneifAuthorized Agent Signature <br /> Date li rivssel 9r23i2 iF,� <br />