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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 'A77 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Oiily.Please) PROJECT SITE ItAFORMATION <br /> PROJECT SITE ADDRESS: 16S-1� �C,Zt(_ Au is PROPERTY TAX#: <br /> LEGAL for new construction: Short Plattsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFOR6VA 1ON <br /> OWNER NAME: TENANT NAME(if Commercial): (?)I0 <br /> OWNER MAILING ADDRESS: STREET PC4c(dr(.( \L't <br /> CITY STATE W4 ZIP q8ut <br /> OWNER PHONE: OWNER EMAIL: 7p{(�I(J l2 Of�1lC(2 <br /> CONTRACTOR NAME: C TLHT(- l7'ecc7 jM,61/-�-tr <br /> CONTRACTOR ADDRESS: STREET <br /> CITY G�GYLV{ { STATE W A— ZIP 61q2D <br /> CONTRACTOR PHONE: 425-25 2-3 1114 ICONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): �(J{-)2�rjs o22� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): C3p s <br /> PRIMARY CONTACT: O OWNER Z CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL; <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: t I Contract Price of Work:$ �d U <br /> Proposed Use of Building: I-& (No e lHeat Source: []Gas []Electric []Other <br /> Building Type: ❑SFR-Detached OSFR-Attached []Duplex []Multi-Family-#of Units: ❑Commercial @Industrial <br /> Type of Project: ONew @Addition @Remodel @Repair OT.I. []Sign @Sprinkler @Demolition @Change of Use <br /> DESCRIPTION OF WORK: <br /> E Gt, bo -1 (At(-6 �O�L NI �P-A-rv(Lr ��"'L S,3e 1 Twp U��Zcac t <br /> t�10 60-VIP" <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 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 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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Oficial Use <br /> -Only <br /> S I(,/' <br /> Ovrner/Auth ize Agent Signature Date (Revised 5/20/2016) <br />