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PERMIT APPLICATION, - <br /> BUILDIN MECHANICAL / PLUMBING / SIGN 1 SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8310 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: (p - PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision __Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME. TENANT NAME(if Commercial)'. <br /> OWNER MAILING ADDRESS: STREET 0A Kf6 Ave, <br /> Cny STATE \AA LIP <br /> OWNER PHONE: LQ t 2,30 OWNER EMAIL: <br /> CONTRACTOR NAME: # <br /> CONTRACTOR ADDRESS: STREET tt- ) <br /> _ C ,. <br /> CITY ";' .,� 'r< <br /> STATE � zip <br /> CONTRACTOR PHONE; -1 r '.... t <br /> `� CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): L . i�:`" � t CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OW1 11 <br /> NER CONTRACTOR ❑OTHER(Please Specify) } <br /> CONTACT NAME: <br /> CONTACT PHONE: .� d <br /> )L CONTACT EMAIL:r <br /> BUILDING PERMIT APPLICATION <br /> Existin Use of Building Contract Price of Work: tQ <br /> Pro osed Use of Buildin Neat Source: Gas XEtectric ❑Other <br /> Building Type SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Pro'ect: ❑New ddition ❑Remodel ❑Repair ❑T.I. ❑Sin ❑Sprinkler ❑Demolition []Changeof Use <br /> DESCRIPTION OF WORK: <br /> 10-1aA dbAbn NQ;F1DW-yV �- (�a5 -F4epVAu.. 4- Pun <br /> ASSOCIATED 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 Fixtures#o! of <br /> — — — <br /> Fixtures <br /> List of Fixtures List of Fixtures List of Fixtures <br /> #of List of Fixtures <br /> 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 Pipinq Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes Dryer—Hookups Other. Clothes Washer Medical Gas <br /> Ran a Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/eta) Other: <br /> SPRINKLER/SUPPRE$SION SYSTEM <br /> Number of Heads <br /> J ----------- <br /> tCKNOWLEDGEMENT 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 /> 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 /> tuilding 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 /> no I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PER I t <br /> tarn r/Authorized Agent Signature Date j1 evised 9123./2016) <br />