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� ����i�-�,���ic�rior� <br /> �UILDIN(3 /�dECHANICAL/ PLUIV��IRI(� / �ICCN / SP�si��f�.ER/ D��VHOLII'60f� <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� www.everettwa.govlpermits <br /> ��s�� o��sa�� ir,� onoy �s����) ��o��c�soY� '��o�nn��rio� <br /> PROJECT SITE ADDRESS: " � '" PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> COIV'TAG7' IPIFOI2MATIOP! <br /> OWNER NAME: , ' � - ,� TENANT NAME(If Commercial): <br /> OWFIER MAILING ADDRESS: sTREEr � <br /> CITY � STATE ZIP <br /> OWNER PHOfVE:`� '? " OWNER EMAIL: <br /> ;r <br /> CONTRACTOR NAME: ' - -• �.- ` `' <br /> CONTRACTOR ADDRESS: sTREer ' O " %� <br /> CITY STATE ZIP [�I� <br /> CONTRACTOR PHONE:-� r CONTRACTOR EMAIL: � - _� ' z �� <br /> CONTRACTOR LICENSE#(REQUIRED): -,IF� ' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � �p�p <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �- u �_ <br /> '���c�� �'-�zf�Y`C� � <br /> CONTACT EMAIL• . `��� ,-a � � � `� <br /> BUILDINC PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ `�J�� U C�'; � <br /> Proposed Use of Building: �� Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: �eSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: >✓� / D��, � ,�n <br /> - � �i c� �� /n 5�..-1 �- A G�r�r r�✓u%/ ��e�� <br /> ��°e�t>r�-,�� � <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 Fixfures #�f List of Fixtures #°f List of Fixtures #°f Lisf of Fixtures <br /> Fixtures Fixtures Fixtures Fi�ctures <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 SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the informafion contained herein is frue 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 aufhorized in writing from the <br /> Building Official before being authorized under any circumstance.l am the owner,or l am authorized by the owner of this prope�ty to pertorm the work for which application is made, <br /> and 1 comply with the Sfate Contractors Law 98.27 RCW and 29G.200A WAC. <br /> City of Everett Official Use Only <br /> PER T# <br /> � �/�' O ool _�_ll <br /> O er/ o ize Agent Signature Date (Revised 9/23/2016) + / ^`� <br /> II. � <br /> � <br />