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PERMIT APPLICATION 'III' <br /> BUILDIN�) MECHANICAL/ PLUMBING/SIGN /ST�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.everettwa.gov/permits <br /> „ ;, , <br /> (Biue or Blackilnk Only Ple....' = PROJECT SITE INFORMA.T,ION �.'., ? <br /> PROJECT SITE ADDRESS: � � PROPERTY TAX#:�, ' �"' (,7`?Qd�`j <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> _ , <br /> ��� ' � �� ���� �� ��CONTACT-iNFORM�TION � a � ��� � <br /> OWNER NAME: �-- (j y-�- LL.(� TENANT NAME(If Commercial): � � � u f'�C�t <br /> I � l <br /> OWNER MAILING ADDRESS: srReer <br /> CIN � STATE w� ZIP q a <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: S <br /> CONTRACTOR ADDRESS: srReer cj , <br /> CITY � STATE � ZIP � <br /> CONTRACTOR PHONE: �� -'�. 'p CONTRACTOR EMAIL: ���� � � � , � <br /> CONTRACTOR LICENSE#(REQUIRED): �[ � `6� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> C NTACT NAME: CONTACT PHONE: ��(,.�-��,� ���`Z� <br /> � � � <br /> ���Y��� L�,j�d �(,G�'�"� CONTACT EMAIL: � -��� S � <br /> BUILDING PERMIT APPLICATION ;, _ <br /> Existing Use of Building: Contract Price of Work:$_ ��d- �O <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �ICommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. �Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,������` �� ��� ��� `\\ �M����� _j � �'i ��' �� <br /> �,1�vU-� �1� �. �k �� <br /> . <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 Lisf of Fixtures #�f List of Fixfures #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/BadMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 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 O�cial before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> � PERMIT# <br /> �r �� b°l � 60 <br /> Owner/Authorized Agen gnature� Dat (Revised 9/23/2016) - � <br />