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PERMIT APPLICATIC' <br /> BUILDIS MECHANICAL / PLUMBING / SIG 'PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> OL 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 Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: L10 &/ f di MAI WLau PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME (If Commercial): 7 r Are <br /> OWNER MAILING ADDRESS: STREET 33 S. <br /> CITY ZA �`� STATE ZIP S O <br /> OWNER PHONE: 6 1-3vi-3'8z)Q OWNER EMAIL: <br /> I <br /> CONTRACTOR NAME: r , S f V1 D <br /> CONTRACTOR ADDRESS: STREET 0) ✓i� j t. <br /> CITY Por­}JAA STATE DR 01 <br /> CONTRACTOR PHONE: 803- 3 -CQI d CONTRACTOR EMAIL: �fiS hn { t .Co' <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER KICONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> Cly{�5 ONr1�v�be{- CONTACT EMAIL; liS. O�Y1t r �2SS�yt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: RC�giI ort Contract Price of Work: $ 300 o0oG <br /> Proposed Use of Building: Heat Source: []Gas [I Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached []Duplex ❑Multi-Family-#of Units: gCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition El Remodel repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Rtfo4 <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 IShower 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> i .r l / <br /> O rized A nt Signature Dat (Revised 5/20/2016) <br /> I Z-- <br />