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PERMIT APPLICATIO <br /> BUILDIN �ECHANICAL/PLUMBING!SIGN�RINKLER/DEMOLITION <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 evereriwa.gov/permits <br /> �BMue�"--B(�ck Ink On1�e�i�a�ej:;: `., , ' �#'t�E�'t'SITE.IN��pR��A�'IQN � <br /> . .. ,. , _, <br /> � . �,: .. <br /> PROJECT SITE ADDRESS: o)`�. � PROPERTY TAX#. � ` <br /> LEGAL for new construction: Short Piatlsubdivision Lot No. (attach co of lon I <br /> py g egai description) <br /> ; �, � � , <br /> '; ` �t'�N'�'��"k';�NF"�ttZiNl�,�"��3N`� ; , <br /> , ,. <br /> � �,s �ti�:� ... , �.: , ,. <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET � <br /> �� � a� <br /> STATE Z�p <br /> OWNER PHONE: � � �� OWNER EMAIL: <br /> __ <br /> CONTRACTOR NAME, � - - . <br /> CONTRACTOR ADDRESS: s�xeer � � � � � U 7 <br /> aTr � � <br /> STATE Z�p <br /> CONTRACTOR PHONE: � � CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): � CITY OF EVERETT BUSINESS LI NSE#(REQUIRED: G ` <br /> � .. .,_ . . . . ,.M-„ . >. _ ...-_ �_ , ; . .. <br /> � �. �.. �_ .... , <br /> �,k_ . <br /> PRIMARY CONTACT: ❑OWNER I�ONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: � CONTACT PHONE: ��rp � � � <br /> CONTACT EMAIL: <br /> � , <br /> �. ` ;BE)��;L��!G:;PERIIl11T APPLI�A�IdN, ' �: ` <br /> � ��. . . �; : . <br /> Existing Use of Building: Contract Price of Work:$ c��C� _ C�� <br /> Proposed Use of Buildin : Heat Source: as ❑Electric ❑Other <br /> Building Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> T pe of Pro'ect: �New �Addition ❑Remodel ❑Repair �T.I. �Sign ❑Sprinkler ❑[)emolition ❑Change of Use <br /> DESCRIPTION OF WORK: „ <br /> ��,G� ����� <br /> ASSOCIATED BUILDING PERMIT# if applicable : <br /> I MECHANICAL PERMiT APPLICATION <. ::,PLUMBINC� PERMIT�PPLICATION : . , _;. <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> Fixtures List of Fixtwes Fixfures List of Flutures Fextures ��st of Fixtures Fixtu es Llst of Finteres <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bldg) <br /> Forced Air S stems 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 Ran e Ductin 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 /> �Rtt�NK1.ER/SUPPRE�SItyN $YSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this applicaSon and confirm the information contained herein is true and correct.Work done pursuant fo 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 fhe <br /> Building Offrcial before being authorized under any circumstance./am the owner,or l am authorized by the owner of this property to perforrn the work for which application is made, <br /> and l comply with the State Confractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> � r � � r 1 �D� '��P� <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />