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PERMIT APPLICATION <br /> BUILDIN ECHANICAL/ PLUMBING /SIGN4477 RINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps,,W_everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1�^� > ' C 1` a PROPERTY TAX#: <br /> LEGAL for new construction: Short Plattsubdivision 'SE E a"! �A4 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �, "I' ,�If� N ill TENANT NAME(If Commercial): Nd" <br /> OWNER MAILING ADDRESS: STREET ;JD-; W,0-4f_ ,p/Zv& <br /> CITY E-4&024 c 4 STATE l +l ZIP <br /> OWNER PHONE: ` , ?, � ,` T 4 OWNER EMAIL: <br /> CONTRACTOR NAME: c7W11I , <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR $LATHER(Please Specify) XaeAl're-41 <br /> CONTACT NAME: FrL's ; 'QAy°°` 4 00�k" �t#'l" CONTACT PHONE: <br /> j-o cal' U07, A/A CONTACT EMAIL: <br /> 13UILDING PERMIT APPLICATION <br /> Existing Use of Building: S F R2. I Contract Price of Work:$ <br /> Proposed Use of Building: SFf. Heat Source: ❑Gas ❑Electric ❑Other dV7114 <br /> Building Type: ZSFR-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: .� c <br /> ,I 1 r:�I..,- 5,V/4�'r td <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> �v <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn _Alteration _IRepair Type of Project: _New _Addn _Alteration __Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures es List of Fixtures Fixtures of <br /> List of 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 Basin) Ddnkinq 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/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:/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.l am the owner,or l am authorr!ed by the owner of this property to perform the work for whkh application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 29-5.200A WAC. <br /> % City of Everett Official Use Only <br /> klCO-fib PERMIT# b V/® q — <br /> Owner/Authorized Agent Signature Date (Revised 10112/2015) ; <br /> 1 <br />