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PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL 1 PLUMBING I SIGN I SPRINKLER l DBMQLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-2578810 1 FAX 425-257-8857 1(E)everetteP$@everettwa.gov I www.everetfws.gov)permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: -elo PROPERTY TAX#J <br /> LEGAL for new construction, Short Plat/subdivision Lot No, _ (attach copy of long lega)description) <br /> JJ CONTACT INFORMATION <br /> OWNER NAME: t f !TENANT NAME(If Commercial)_ <br /> OWNER MAILING ADDRESS: STREET ffku 7 <br /> 0 12L <br /> crrrVpp-e# STATe z,a <br /> OWNER PHONE: - OWNER EMAIL-: <br /> CONTRACTOR NAMES UJA-5q111JGt7TZN &ff lZ <br /> CONTRACTORA00i2ESS: STREET 1-1v5Z ilL�� i-vt Vo UX fq <br /> 2-69 <br /> CITY `J VY 1 STATE UJ/3- ZIP <br /> CONTRACTOR PHONE: q2,6-93- W71 <br /> ! CONTRACTOR EMAIL: W, Y c- <br /> 1hP5�6�• <br /> CONTR,ACTOFZ LICENSE#(REQUIRED): tnr� � p CITY OF EV)=RETT BUSINESS LICENSE#(REQUIRED): 0 6 3 <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CON} �fr�Lp TACT NAME- CONTACT PHQIN <br /> ( <br /> V I DCONTACT EMAIL; <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of ork:$ <br /> Proposed Use of Bu din : Heat Source; s ElElectric ❑Other <br /> Building Type: f7-Detached ❑SFR-Attached 00u&X 11Multi-Family-#of Units: ❑Commercial ❑Indo 4-- <br /> Type of Project: ❑New MAddition ❑Remodel G] f Us <br /> DESCRIPTION OF WORK: i <br /> C(�w r�-t �- /ao waj'v <br /> ASSOCIATED BUILDING fat=lRMIT# if a licablg: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteratlon _Repair Type of Project: _New Addn Alteration _,Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of !-1st of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC—Air Handling Units Heat Pump Toilet Backflow Preventer Inside Bldg: <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler I,avata (Wash Basin) Drinkin Fountain <br /> Water Heater —Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stave Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink ServicelBarlMopietc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNO WLEDGi5M1ElVr.1 have reviewed this application and confirm the informgilon contained herein is true aad Correct.Work done pursuant to this permit rnnst Compir with <br /> cormni federal,state,and local few. The granting of a permit only authorizes approved won't And no deviations therefrom.Deviefions must first be authorized in writing from the <br /> Building Official before being authorized under any&CUMStaaCe,l 8m the owner,or I am avfhorized by the owner of this property fo perform the work forwhich appii=llon is ma( <br /> and I comply with the State Contractors Law 18.27 R and 290,2ooA WAC. <br /> City of p'vereft Official Use Only <br /> PERMIT# <br /> 4,j(01w uthorizedAflentSignature Date (Revised.5120a0161 <br />