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PERMIT APPLICATIC}R� � <br /> BUILD�I U I MECHANICAL/ PLUMBING I SIGEESPRINKLER I DEMOLITION <br /> CITY OF EVERETT 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 /> .IG'T.S1TE INFORMATION . . ._'.c= ;;" ..... <br /> PROJECT S T SS: PROPERTY TAX#: j <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach opy of long legal description) <br /> is <br /> ONTA4rT;iNFQRMATIION '`" <br /> OWNER NAME: \ 6/3 <br /> f' Lr h1a TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET Vi- I I 14— <br /> E� <br /> 9 CITY STATE IF <br /> a <br /> OWNER PHONE: 1 — —p� O OWNER EMAIL: �b <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET /vy�' _ <br /> CITY STATE ZIP ^"s��n <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): l� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONT CT NAME: CONTACT PHONE: <br /> ��Sl��� CONTACT EMAIL: 0 k r <br /> - - BU;ILIDINO-PERMIT APPLICATIDN. .,...: <br /> Existing Use of Building: Contract Price of Work:$ y <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 EIRemodel (-]Repair ❑T.I. ❑Sign ❑Spr/in�kler ClDemolition oChange of Use <br /> DESCRIPTION O WORK: L_ 6"�� � � 'VLCf� ���Vt CL <br /> l S <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APALICATION` - <br /> PLC)'IVfSfNC� PE..RMIT APPCfCATION. <br /> Type of Protect: _New _ Addn _Alteration _Repair Type of Project: _,New _Addn ._Alteration _,Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures <br /> Fixtures Fixtures Fixtures` <br /> A/C—Air Handling Units Heat Pump Toilet Backflow r voter(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub „� Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) ri[9 n n <br /> Water Heater Refrigeration Shower Floor Drai <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos t r T a <br /> Gas Range Ducting Dishwasher e;;7 a <br /> Clothes Dryer Hookups Other: Clothes Washer Medlcat Gas <br /> Range Hood C4 a Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> :', ;;:_:•SPRINKLERa_SUP PRRSSION: <br /> 'SYSTEM`:,_ :: <br /> Number of Heads <br /> ACKNOWLEDGE ENT.1 have reviewed thi pplicati n and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,sta e,and loc law.The grant go <br /> ermit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official b ore being uthori d unde any cumstance.I am the owner,or am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply"with tate C ntractor aw 8.27 and 296.200A WAG. <br /> City of Everett Oficial Use Only <br /> OwnerlAuthorized A e t gnatur Date (Revised 1`0/92/2095) <br /> l <br />