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����i9�'.Af�IPL9CATB0� <br /> ��18�.�eNG I f�ECF°SANICAL I ��.11����lG 1�IG�91 SPR9NP�L�R/ DEt�iOL9TlOi� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 42_5-257-8857 �(E)everetteps@everettwa.gov� www.everetfwa.gov/permits <br /> ��o��o�-�'���a����ay�s��s�) �������-�a�� '����n�W�'�a� <br /> PROJECT SITE ADDRESS: �.Y��� ��5�2�� R• PROPERTY TAX#: �G����(7�0�l�f <br /> LEGAL for new consfruction: 5hort Plat/subdivision Lot No. (attach copy of long legal description) <br /> COIeI'T'AC`i" IPI�ORMl4`I'90F6 <br /> OWNER NAME: p1/Q�S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRee-r � U. )`�02 �]� <br /> � CIT' .� � ' ��j�j�/�- STATE� � ZIP (V O�� <br /> OWNER PNOPIE: �--�����g OWNER EMAIL: �_ e <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: sTRe�r <br /> C�7'y STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSiNESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUIL�ING PERIUIIT APPLICATION - <br /> Existing Use of Building: Contract Price of Work:$ -S�' � <br /> Proposed Use of Building: Heat Source: �Gas ❑Elec Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodei ❑Repair ❑T.I. ❑Sign ❑Sprinkfer ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��`� ��� (� � �Q`�,�R ��r„a�� �G°�`��y <br /> ..�- ��'> > <br /> �,�,��.y Roo,� v�- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLI�ATION <br /> Type of Project: _,New Addn _Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixfures #of Ust of Fixtures #°f Lisf of Fixtures #�f List of Fixtures <br /> Fixtures Fixtures Fi�ctures Fi�cfures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <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/BadMop/etc.) Ofher: <br /> SPRIh9KLEfi/SUPPRESSIOM SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this appfication and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and/oca!law.The granfing of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from fhe <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to pertorm the work for which application is made, <br /> and 1 comply ith State Contractors La 8.27 and 96,200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# <br /> � C�I7�Co --�o� <br /> Owner/Autho �zed Agent Signature Date {Revised 9/23/2016) <br />