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PERMIT APPLICATIO <br /> BUILD . 3 / MECHANICAL/ PLUMBING /SIG PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 4e7T (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 pPlease) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: �(t: <br /> LEGAL for new construction: Short Plat/subdivision LJ'0 Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: (aN TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET` 1\ <br /> 1,I C�j k 1;m+ — as I L(zt;z{ ' �ALVOiJ L P tAX <br /> 2 4 CITY y L Uvt VL' C STATE �� ZIP <br /> OWNER PHONE: J((%C �l 1 G�7i3 OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET �-bl) `lt`Y'1,��1T' Z;;Wl:t - <br /> CITY E�l L� STATE LUQ A <br /> CONTRACTOR PHONE: vt% 4i(L�(? CONTRACTOR EMAIL: t <br /> CONTRACTOR LICENSE#(REQUIRED): ZCITY OF EVERETT BUSINESS LICENSE#(REQ D): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE; �1� ��(; <�C`�� <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION i <br /> tey <br /> Existing Use of Building: t, 1�7� JS- l C( lam'— Contract Price of Work:$ i <br /> Proposed Use of Building: `.,rwtr / YVQ. lHeat Source: ❑Gas NElectric []Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Uni4. Comm eial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign Elsprinl6qr ❑Demolition-'-❑Change of Use <br /> DESCRIPTION OF WORK: '- <br /> /kPIJ ("o SIN ` s ( [? SPPtj, <br /> L li PI(At evil-cC1 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): l (r <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 # f List of Fixtures #of 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 Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range IDucting 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.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. <br /> City of Everett Official Use Only <br /> PE IT# <br /> Owner/A thorized gent Signature IDate (Revised 5/20/2 16) ` <br /> J�Z f <br />