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y34-153 PERMIT APPLICATION <br /> BUILDIN( ECHANICAL / PLUMBING / SIGN IRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIGca <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <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 Only;Please) PROJECT SITfE` INFORMATION <br /> PROJECT SITE ADDRESS: [C U I 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 ADDRE STREET p ' F IDS <br /> CITY STATE -P!ai q <br /> OWNER PHONE: OWNER EMAIL: ,[`akA <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: sT T{,� l.t�k <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: L CONTRACTOR EMAIL: 442nrl <br /> CONTRACTOR LICENSE#(REQUIRED): ML&a3a6 06 CITY OF EVERETT BUSINESS LICENSE#(RE IRED) <br /> PRIMARY CONTACT: ❑ OWNER L?1 0NTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAM ` CONTACT PHONE: <br /> r1 r1 hE 'fin CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas El Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial [Industrial <br /> Type of Project: ❑New ❑Addition ❑ e odel ❑Repair �ElT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Jn,`t„p�CQ Gt.O ✓1�2�rY. L�jy�� c,�,�n f�� SLt' V KV S ,� 1 D—oZ6 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of #of #o #of <br /> List of Fixtures List of Fixtures List of Fixtures 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 Ba's Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal `'�_ Grease Trap <br /> Gas Range I Ducting Dishwasher R-gof 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:1 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.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I compI with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ICity of Everett Official Use Only <br /> II PER I <br /> Owner/A thoFzed Agent Signature Date i (Revised 9/23/2016) �/� <br />