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PERMIT APPLICATION <br /> BUILDIJP MECHANICAL I PLUMBING I SIGNMRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIOW <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 /> 71 <br /> PROPERTY TAX lq <br /> PROJECT SITE ADDRESS: PROPE <br /> j�&bd L <br /> LEGAL for new construction: Short Plat/subdivision-Lot No. (attach copy of long legal description) <br /> M <br /> -T <br /> 77777777=: <br /> OWNER NAME., TENANT NAME(Ifi Cammercial): <br /> OWNER MAILING ADDRESS: STREET <br /> STATE *194 3;7— <br /> CITY <br /> OWNER PHONE, i Q OWNER EMAIL: <br /> CONTRACTOR NAME: dw <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE 71P <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): 1CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER El CONTRACTOR OTHER(Please Specify) Wolo*kf lwrz_� <br /> CONTACT NAME: CONTACT PHONE: <br /> pr <br /> CONTACT EMAIL: <br /> CIE -'A <br /> Existing Use of Building: <br /> Proposed Use of Building: HeatSource: UGas Wectric 00the <br /> - w <br /> Building Type: EISFR-Detached EISFR-Aftached *Duplex DMulti-Family-#of Units:===.. MCommercial ElIndustrial <br /> Type of Project: FINew MAddition EIRemodel Qpair CIT.L 0$ign Elsprinkler Ell)emolifion OChange of Use <br /> DESCRIPTION OF WORK: <br /> 4t. y4ff <br /> row6o'—p 0( <br /> 1ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ."..MECHANICAL� . ... . * " .. PE <br /> IIRMI <br /> JM �N-Q- . CA-T <br /> RMf <br /> Type of Project: _.New Addn —Alteration —Repair Type of Project: _New —Addn AWAlteration _Repair <br /> 70--f <br /> —#Of #of #of List of Fixtures List of Fixtures <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures Fixtures 'Backflow Preventer(inside Bldg). <br /> A/C—Air Handling Units Heat Pump Toilet <br /> Forced-Kir 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 A, Kitchen Sink&Disposal Grease Trap <br /> Gas Range <br /> Ducting —.Dishwasher Roof Drains <br /> Clothes Washer Medical Gas <br /> Clothes Dryer Hookups Other <br /> Water Heater Other: <br /> Range Hood <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. <br /> IINKL <br /> Number of Heads <br /> I 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 locallaw.The granting of permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Buildingcifficiai before being authorized under any circumstance,lain the owner,or I am authorized by the owner of this property to perform the work forwhich 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 /> [ <br /> PERM MI, ' <br /> �wnerl!�uthed Agent Signature Date (Revised 1011,112015) <br />