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PERMF APPLICA`I O PC- <br /> "-Pc>•o F <br /> [�WLDIP MECHANICAL/ PLUMBING /�ICvN PRI1�91 LER/ DEMO L f ION <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@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or 89ack Ink Only Please) PROJECT S95TE II�9IFORMATION <br /> PROJECT SITE ADDRESS: ! C I'v T PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: jryl r`,6- C T(GI+ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET q311GcC�T �}vC; <br /> _ <br /> CITY (��/C���-jam] a- ��3 <br /> cr / STATE C'kj ZIP <br /> OWNER PHONE: LIZ5. qv3. 2 LIYc OWNER EMAIL: wruE E�1 L CO <br /> CONTRACTOR NAME: (:or-c---q2 k /VaQ7f><�c <br /> CONTRACTOR ADDRESS: STREET 12'710 <br /> /O L',�o�T1n � <br /> CITY Lk• C-V�=+`�S STATE l.iL/ ZIP <br /> CONTRACTOR PHONE: O�o.,71 413/ I CONTRACTOR EMAIL: Son �Fcx�l�/IJgZTF/c�`�CCXiYJ <br /> CONTRACTOR LICENSE#(REQUIRED): JeODIFW N k O r O 4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: APNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z CC 74' L/Cf 3 f <br /> �/� /!/b!�/�csd✓U <br /> CONTACTEMAIL: Sr-YAC C0FL-ZfkS/Lbe7{`1<7 CC) <br /> BUILDING P1ERM9T APPLICATION <br /> Existing Use of Building: PCw'TAL I Contract Price of Work:$ Op0 <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric []Other <br /> Building Type:. FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: El New OAddition ❑Remodel ❑Repair ❑T.1. ❑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 ust of Fixtures #of 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 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 SYS'T'EM <br /> Chemical or Water NO. 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 Oficial before being authorized under any circumstance m the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply 'h the State Contractors Law 18.27 RCW 96.200A WAC. <br /> City of Everett Oficial Use Only <br /> PERMIT I � <br /> 16 1 o I o` <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) 1 <br />