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PERMIT APPLICATION <br /> BUILDIN*ECHANICAL / PLUMBING / SIGNWRINKLER/ DEIAOLITI014 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Z��'�. j J �� PROPERTY TAX#: QQ c VL O QQ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: M\l lam_ TENANT NAME(If Commercial): 1 +lo 6",fir, ►�J�Ui' <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE CJI- ZIP 01 Vtv <br /> OWNER PHONE: , �j(pj OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET ` ��] �jv\�t'11✓ <br /> CITY � �\,��— STATE V�� ZIP 9 10 <br /> CONTRACTOR PHONE: –2a 0. I?D&3 , (9—It CONTRACTOR EMAIL: S"sa� rz(` yY1 Y`�tJ, Olry1 <br /> CONTRACTOR LICENSE#(REQUIRED): CO-'+t-kE I� t^ U`p CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Z <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR XOTHER(Please Specify) t� � <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: cvvv5 5 L�' �G� , 45.� <br /> BUILDING PERMIT APPLICATION <br /> ExistingUse of Building: l� DDO <br /> g �j��j11Jl�5 ��� Contract Price of Work: $ <br /> Proposed Use of Building: I Heat Source I9as lectric ❑Other <br /> Building Type ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: W1ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair T I. ❑Sign ❑Sprinkler ❑Demolition ❑Chancre of Use <br /> DESCRIPTION OF WORK: <br /> t5 �45iT� <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 #of #of #of <br /> List of Fixtures List of Fixtures 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 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater 1 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.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 1 am authorized by the owner of this property to perform the work for which application is made. <br /> and I comply with th -State Contractors Law 18.27 RCW and 296 200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Author¢ed Agent Sign ure Date `U (Revised 5/20/2016) <br />