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PERMITAPPLICATKIN <br /> BUIL DID/ MECHANICAL_I PLUMBING I SI SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 l(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITEANPOkMATION _ <br /> PROJECT SITE ADDRESS: ((� �C� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Z TENANT NAME (If Commercial): <br /> OWNER MAILING ADDRESS: STREET 5510 O -- c <br /> CITY STATE ZIP [ �3 <br /> OWNER PHONE: A.11A OWNER EMAIL: <br /> CONTRACTOR NAME; �fAK <br /> CONTRACTOR ADDRESS: STREET 7-1 LU <br /> CITY STATE Lc/.'\ ZIPS <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED); CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: O OWNER CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE t'fz_i�; J7(/ <br /> CONTACT EMAIL: <br /> BUILDING PERMIT.APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: ]Heat Source: g22s ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached @Duplex []Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project:'El New OAddition ❑Remodel ORepair OT.I. @Sign ❑Sprinkler ❑Demolition []Change of Use <br /> DESCRIPTION OF WORK: <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units L 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/SUPPRESS10H SYSTEM <br /> Number of Heads J I <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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contractors Law 9 7 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 4- 1PERMIT# <br /> Owner/Authonz d Agent Signature Date (Revised 5/20/2096) <br />