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<br /> PERM[T APPLICATION
<br /> BUILDING 1 MECHANICAL 1 PLUMBING/SIGN/SPRiNKLER 1 DEMOLITIt�N
<br /> CiTY OF EVERETT PERMIT SERVICES �
<br /> 320�CEDAR STREET,EVERETT,WA 98201
<br /> (P}425-257-8810 � FAX 425-2�7-8857 �(E)everetteps@everettwa.gov� www.everetiwa.gov/permits
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<br /> P_ROJECT SITE 1N�O.RMATION �
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<br /> PROJEC7 SITE ADDRESS: �r1 PROPERTY TAX#:
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<br /> LEGAL for new construction: Short Plat/subdivision Lot No. {attach copy of long legal description)
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<br /> -;.<'. . �. ,t •< . 1 =:: ....,;: , ,:CONTACT INFORM.,AT,,ION:: �� ``
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<br /> OWNER NAME. TENANT NAME(If Commercial); � �
<br /> OWNER MAILING ADDRESS: sTReer r,(� �[ �� �
<br /> CITY "pj STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
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<br /> CQNTRACTOR NAME: � Lj t
<br /> CONTRACTOR ADDRESS: STREET ' Gj (' �� �j
<br />� CITY STATE ZIP � • �
<br /> CONTRAGTOR PHONE: �'� �--� �j COM1fTRACTOR EMAIL: .eC �IVL �GD
<br /> CONTRACTOR LICENSE#(REQUIRED): L CITY OF'EVERETT BUSINESS LICENSE#(REQU ED): \ .�'
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<br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER{Please Specify) /�I nI�G' j
<br /> CONTACT NAME: CONTACT PHONE: `'� � �— �–_. � #
<br /> U,\ l.�r�C � CONTACT EMAIL: �p Iil. l�. l �� ('19 " C�
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<br /> - � r � - BU,.ILD1NG.tPER .M..IT,APPLICATION, 7,.;� �,�.,,�_:� � .,.
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<br /> Existing Use of Building: Contract Price of Work:$ 1�
<br /> Proposed Use of Building: Heat 5ource: ❑Gas ❑Electric Other � �
<br /> Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil �of Units: ❑Commercial ❑Industrial �
<br /> T pe of Pro'ect: ❑tVew �Addition Remodel ❑Repair ❑T.1. ❑Si n ❑S rink(er ❑Demolition ❑Change of Use t
<br /> DESCRIPTION OF WORK: �
<br /> ASSOCiATED BUILDING PERMIT#(if applicable:
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<br /> ,_, ��MECHhN1CAL PERMIT APPLICATION;�... ; 1.:;; , .;.;��: PLUMBING;PERMIT APPI.ICATION
<br /> Type of Project: _New_ Addn Alterafion _Repair Type of ProJect: New Addn Alteration _Repair
<br /> #of �st of Fixfures �°f Lisf of Fixfures #of List of Fixfures #°f List of Fi�cfures
<br /> Fixtures Fintures Fi�ctures Fixtures �
<br /> A/C–Air Handling Units Neat Pump Toilet Backflow Preventer(Inside Sidg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boifer Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shawer Floor Drain
<br /> Gas Fire lace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes D er Hooku s Qther: CloEhes Washer Medical Gas
<br /> Range Hood Water Heater Other.
<br /> Exhaust F'an Sink{Service/BaNMop/etc. �ther:
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<br /> ��_ �:SPRINKLER:/$UP��ESSIO�! SY$TEM:, . .:y
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•I have reviswed this application and confirm the informafion contained herein is true and correct.Work done pursuant to this permif must comply wifh
<br /> current federal,state,andlocailaw.The granting of a permlt only authorizes approved work and no deviations theref�om.Deviations must first be authorized!n wrifing from the
<br /> Building O�cia!before being authorized under any circumstance.l am fhe owner,or I am authoRzed by the owner of this proper(y to perform ihe work for which application is made,
<br /> and 1 comply with fhe State Contracfors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everetf Official Use Only
<br /> /9 PERM � I�U�//'�/C '
<br /> l%%d' UlJ
<br /> Owner/Authorized gent Signature Date (Revised 10/12/2015)
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