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����i�r�,��Lic�,rior- <br /> BUILDIh.: . i�ECHANICAL/ PLUIVi�IIVG 1 SIGM 1 �NRINKLER/ DEMOLII'ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJEC7'SITE INFOFtMl�T10N <br /> PROJECT SITE ADDRESS: �Z-`� �Z\\!�'_(-'S ; LI�,� �JJ�2�� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTAC°T INFORMATION <br /> OWNER NAME: V T [v I L�...� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREET C>. �'� 7 � <br /> CITY - .e r " 'e, STATE �/ 7 • � ��� <br /> OWNER PHONE Li��� p - ���Z 3 OWNER EMAIL: m�(� = P�1 N ��1 i �N • �I Z <br /> CONTRACTOR NAME; W `��C-IL1 /�' ��l ' C�i I ( <br /> CONTRACTOR ADDRESS: srReeT I [j ` �b �i c,�� <br /> CITY �_�J'C�j^�'.. STATE ��T� ZIP � � <br /> CONTRACTOR PHONE: � Z,�j= ��' �� � � CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): ��J�� <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �'�� . ��S�j "�j � �� <br /> 1���C�� ��`.C���(�C(,�C--�� CONTACT EMAIL: n'l,l�C�✓1�� � �.' ��P G I<-, rv 6�.l I�E f>'1 v, �0 VY� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ �� b 6�. � <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 ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �j'v�d� ��C b-�.� C�� F� �LS�C F I�S� �(.�c � C /' S <br /> J <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 Lisi of Fixtures #of List of Fixtures #�f List of Fiztures #°f List of Fixtures <br /> Fixfures Fixtures Fixtures Fintures <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 /> Ciothes 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 /> Chemical or Water No. 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 autho�izes 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 perfiorm the work for which application is made, <br /> and I comply with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Offrcial Use Only <br /> `��s��� ��—�'�'�.�c�� � ' � ' I .� P M I��� ` � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/20f6) <br /> ��� <br />