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��4�i�di9T A��L�CP+�TEOi� <br /> �U�L.DIi�G / f�fiiEC�ANICAL I PLU('�1�0�G I S9G�4 15�6�96���ER/ �EI�IiO�BT10V� <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 /> �lue or �lacbs lu��s �nly Please) �'���D����IT� i�����4fiW"r10� <br /> PROJECT SITE ADDRESS: y �,'u � � ' � � . � ��•- � � <br /> � g �- �r PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �OIV'Y'AC`Y IT1FOFtINlA�90�1 <br /> OWiVER NAME: L�/'�G r�� � �' L� � TENANT NAME(If Commercial): � ° '�'� ��+ � ' Q. � ' <br /> OWNER MAILING ADDRESS: sTREET �CI��} �'�'�l <br /> CITY � STAI� ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; 1 < " � - + ` L � , <br /> CONTRACTOR ADDRESS: sTREeT � � L ' �. �,�I <br /> CITY `- � �� ��___ STATE ZIP � `.�r � <br /> CONTRACTOR PHONE: �j(�"� ; ���y� �� CONTRACTOR EMAIL: �J. ;t�; � (.-(,) S 1%� I t-. , (- G� \ <br /> CONTRACTOR LICENSE#(REQuiRE�): L i1 rJ�f GL !,� � Z- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �[> �� <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �Z � - '7 � -. <br /> � '`-�t9�-! � (�:z1�C.'�,� � CONTACT EMAIL: ��1C /��'. . Clc,? /Ie�K �c• w1�; . .` c�l <br /> BU9LDING PERMIT APPLICA'TION <br /> '�xisting Use of Building: < r Contract Price of Work: $ � ��� —1 <br /> roposed Use of Building: ti � , Heat Source: ❑Gas lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: f�4Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> lL'9.,5�1 1% �VJ'�c:���:sv.9�-��1�- I r 3 �" �c�.;-�.:i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLl�ATION <br /> Type of Project: _New _ Addn _Afteration _Repair Type of Project: _New �,�Addn _Alteration _Repair <br /> #of Lisf of Fixtures #of List of Fixtures #°f List of Fixtures #°f 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) 1 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/ SUPPlZESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> m irrent federal,state,and local law. The granting of a permif only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> ilding Official before being authorized under any circumstance.I am the owner,or I am authorized by tire owner'of this property to perform the work for which application is made, <br /> ��I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Otficial Use Only <br /> � PERMIT#�) �( <br /> v'`y '�� �/ - r?�l- 2�>� 7 f � (-� C' I� d t� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />