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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING/SIGN/SPRINKLER/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.govipermits <br /> (Blue or Black!nk On1y,Pleas�} PROJECT.SITE INFORMATION <br /> PROJECT SITE ADDRESS: r�Q PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACTINFORMATION SC S <br /> OWNER NAME: TENANT NAME(If Commerciaq: x' r� <br /> � <br /> OWNER MAILING ADDRESS: srReer <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: (,�,'�'�� ° <br /> CONTRACTOR ADDRESS: sTReer D�J Q`�'h � <br /> CITY ,,i� E STATE ZIP �� <br /> CONTRACTOR PHONE: �� e CONTRACTOR EMAIL: � j .�. Q <br /> CONTRACTOR LICENSE#(REQu1RED):R�t' �� '�� CITY OF EVERETT BUSINESS LIC NSE#(REQUIRED): ` <br /> PRIMARY CONTACT: ❑OWNER CON7RACTOR ❑OTHER(Please Specify} <br /> CONTACT NAME: �� ��l�� CONTACT PHONE: �Z� � ..�Cr�"" <br /> CONTACT EMAIL: A a <br /> "�i � ",�s <br /> ` Bur��a��G ��Rnn��r s►pr���carroM <br /> Existin Use of Buifdin : �� Contract Price of Work:$ <br /> Proposed Use of Buildin : � Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detacfied ❑SFR-Attached ❑Duplex ❑Muiti-Famil -#of Units: Commercial ❑Industrial <br /> T e of Pro'ect: ❑New DAddition Remodel �Re air �T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> Rouyl���� 1,, Was1��� 8nX¢15kawe�. Al�o ReP�ac,i�y 6Ja�e+r Wea�r <br /> ASSOCIATED BUILDING PERMIT# if a licable: � ���'b�a <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 #of List of Fiarfures #of List of Fixtures #�f List of Flxtures <br /> Fi�ctures Fixfures Fi�ctures Ffxtures <br /> AIC—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld <br /> Forced Air S stems Unif Heater Bathtub Urinai <br /> Gas Pi in Boiler Lavato Wash Basin) Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink&Dis osal Grease Tra <br /> Gas Ran e Ducfin Dishwasher Roof Drains <br /> Clothes D er Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other: <br /> SPRINKLER`!SUPPRESSION SYSTEM< <br /> Chemical or Water No.of Heads <br /> ACKIVOWLEDGEMENT.•1 have reviewed this application and confirm the information contained herein is true and croirect.Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The gran6ng of a pemrit oniy authonzes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial before being authonzed under any circumstance.l am the owner,or 1 am authorized by the owner of this property to peAorm the woHc for which applica6on is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# <br /> � � i l'ld�- o �� <br /> Owner Aut orized Age Signature Date (Revised 9/23/2016) <br />