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PERMIT APPLICATION <br /> BUILDII'- MECHANICAL/ PLUMBING I SIGN -'RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 -1(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> PROJECT SITE ..PIR <br /> IRjF ON <br /> PRO— <br /> PROJECT SITE ADDRESS: 11 <br /> l&yjyV�0� fiTY TAX#:"ER <br /> LEGAL for new construction: Short PlaYsubdivision- Lot No. (attach copy of long legal description) <br /> COhITACT; <br /> AT <br /> X OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> C" STATE ZIP <br /> CONTRACTOR PHONE: -1CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: El OWNER 0 CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: I CONTACT PHONE: <br /> ICONTACT EMAIL: <br /> .............. <br /> tj j L' j <br /> - <br /> .ERMIT APPLICATION, T <br /> .... <br /> Existing Use of Building: lContract Price of Work: <br /> Proposed Use of Building: lHeat Source: E]Gas DElectric ElOther <br /> Building Type: EISFR-Detached EISFR-Attached ODuplex E]Multi-Family-#of Units: ElCornmercial ElIndustrial <br /> Type of Project: EINew MAddition EIRernodel EIRepair 11T.I. 0Sign []Sprinkler OlDernolition OChange of Use <br /> DESCRIPTION OF WORK: �D � <br /> Aj-� b I n'� V <br /> `'V` /kMfJ -�A 0 <br /> JASSOCIATED BUILDING PERMIT (if applicable). <br /> C -E <br /> M CHANIU APPLICATION Tt CATION <br /> Type of Project:. —Nt A dn —Alteration _Repair Type of Project: _New(,X, Ad ---Alteration —Repair <br /> #of #of of #of List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 i.suploots$1101w <br /> lNumber 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/am authorized by the owner of this property to perform the work for which application is made, <br /> comply with the State C ntractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> and <br /> ��1� a I ti PERMIT <br /> n <br /> 'r (Revised 1011212015) <br /> Owner/Authorized Agent Si Date <br />