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PERMIT APPLICATIO <br /> BUILDINAECHANICAL/ PLUMBING /SIGN / I RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4e7T 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: S / �/ etsId PROPERTY TAX#: R-,-00 <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFO ATION <br /> OWNER NAME: P r — / Ai/2l= r/ TENANT�NAME(If Commercial): XZ2L <br /> OWNER MAILING ADDRESS: STREET ri J D U U <br /> CITY �T Z STATE ZIP U'/ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: S G G/ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE b11 ZIP <br /> CONTRACTOR PHONE: 6/z J CONTRACTOR EMAIL: J <br /> CONTRACTOR LICENSE#(REQUIRED): P,95 SR- <br /> 60 OaITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: O-OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> 13/ CONTACT EMAIL: i <br /> BUILDING PERMIT APPLICATION > <br /> Existing Use of Building: � Z! L Contract Price of Work:$ / v <br /> Proposed Use of Building: Heat Source: ❑Gas []Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 1:1 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: r�L � �/� - / / <br /> S l!� /� �h�S r��// �"7'� reL r�� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1 0 ! 3 0 <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 #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 I 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.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERM' <br /> P[ / q� <br /> caner/Authorized Agent Signature Date (Revised 5/ 0/2016) U <br />