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PERMIT APPLICATION <br /> BUILDRO MECHANICAL/ PLUMBING I SIGNAWRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIO–W <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 /> SITE IN 0 IV <br /> lAT! <br /> PROJECT SITE ADDRESS: PROPERTY TAX M <br /> LEGAL for new construction: Short Plat/subdivision—Lot No. (attach copy of long legal description) <br /> CONTA�T'I <br /> aM U <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET f <br /> CITY Li 11 til V STATE ZIP <br /> W C <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (06! -r <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: 1CONTRACTOR EM.AIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED)- <br /> PRIMARY CONTACT: El OWNER El CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: (�p 77 ffw a q6t, CONTACT PHONE: ?-U 5-i�13-2 X SZ A <br /> CONTACT EMAIL: <br /> 4 <br /> R OWPE M T <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: lu—+ Gas ElElectric ElOther <br /> Building Type: EISFR-Detached EISFR-Attached ODuplex E]Multi-Family-#of Units: [:]Commercial ElInclustrial <br /> Type of Project: ONew MAddition EIRemodel EIRepair 13T.I. 0Sign ElSprinkler OlDemolition OChange of Use <br /> DESCRIPTION OF WORK: fl 5J1A4!il Q 01�, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> T- -10-N POMO(06.PtRIVI <br /> 0190-A, _Repair _New Addn ____Alteration _Repair <br /> Type of Project: —New Addn _-Alteration —R ir Type of Project: <br /> #Of <br /> #of List of Fixtures <br /> #of List of Fixtures #of 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 I 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 /> -W* <br /> Number of Heads <br /> ACKNOWLEDGEMENT'l 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. City of Everett Official Use Only <br /> PERM! # <br /> C1 I G1 <br /> (Revised 1011212015) <br /> OwnerlAuthorized Agent Sign ture Date <br />