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'I' III PERMIT APPLICATION <br /> BUILDI�tl�+iNECHANICAL/PLUMBING/SIGN /�I�NKLER/DEMOLITION <br /> CITY OF EVERETT PERMITSERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everetfinra.gov( www.everettwa.gov/permits <br /> � � � ��� PROJECT SITE'��INFO[tMATiON . � � � �� <br /> PROJ�T SITE ADDRESS: PROPERTY TAX#: <br /> � dl��/�� <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � .e�� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReET /��(f ` ��f�'/ � <br /> � / <br /> CI1Y � � STATE ZIP 9 ���� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: srReer <br /> CIN � STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR IICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0�. D <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify)�, ,��. . �_ J� <br /> CONTACT NAME: CONTACT PHONE: �� �'r "�' <br /> ,� � ��' CONTACT EMAIL: � � � ; � <br /> : BUILDING PERMIT APPL1�ATl�N ' <br /> Existing Use of Building: ,jt�` " Contract Price of Work:$ �!� <br /> Proposed Use of Building: ,�� �E� , Heat Source: ❑Gas a�lectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ulti-Family-#of Units: �� ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � ��������' �� �,� <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MEGHANICAL PERMIT APPLICATION PWMBING 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 Fixtures #of List of Fixfures #of List of Fixtures <br /> Fixtures Fixtures Fixfures 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/BariMop/etc.) Other: <br /> SPR{NKLER,/Sl�b*I�C�E�$!QN SY$TEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information confained herein is true and correct.Work done pursuant to this permit must comply witir <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perfo�m the work for which application is made, <br /> and I comply with the State Contrectors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# : ^ ' D�� <br /> �J <br /> < <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> f V � <br /> � �� <br /> ``'`__... <br />