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PERMl7 APPLICATI <br /> IBUIL� MECHANICAL/PLUMBING /SIG RIiV�LER/DEMOLITION <br /> CITY OF EVERETT PERMIT SER <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-881 D J FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everetiwa.gov/permits <br /> (Blue or�lack Ink Only Please) PROJECT SITE INFOttMA'TIOtd <br /> � <br /> PROJEC7 SITE ADDRESS: 's� (�� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (at#ach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �t'- �' ^ TENAN7 NAME(If Commercial): <br /> r-- <br /> OWNER MAILING ADDRESS: sTReer � <br /> crrY �" STATE ziP 3 <br /> OWNER PHONE: �j OWNER EMAIL: <br /> CONTRACTOR NAME; �, ►�� � <br /> CONTRACTOR ADDRESS: STREET Z v S l� D' <br /> ��, STATE Z�P vr <br /> CONTRACTOR PHONE: � S-,3 3 CONTRACTOR EMAIL: � ,�� � <br /> CONTRACTOR LICENSE#{REQUIRED):y-t(.(,�l�J�, �"l c�� CITY OF EVERETT BUSINESS LICENSE#(REQUI D):vS f 7 7S <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (��� �3� � � <br /> ( �,� � � CONTACT EMAII.: � <br /> BUILDING PERMIT APPLICATIO <br /> Existing Use of Building: Contract Price of rk:$ S �G � <br /> Proposed Use ofi Building: Heat Source: Gas �Electric ther <br /> Building Type: ,IE7SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�#of U ' ommercial ❑Industrial <br /> Type of Project: ❑New �Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �����N�7 �L�� ������ �,l�U f�� S�!���Q (.�OC!�'t'-"C Z�v�,� <br /> ..J �,.�, <br /> �' !� C.��t..), ./t/�C�J l��(�t �mcS ��rJ�. i U r..�c�t..S �'�4J—(7 Q•��'L. ,�.c7 C.ft'i�C��,] <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIGATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #of /�st of Fixtures #of Ust of Fixtures #of List of Fixtures #�f List of Fixtures <br /> Fixfures Fixfures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump ( Toilet Backfiow 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 /> Ciothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan ( Sink(Service/Bar/Mopietc.) Other: <br /> SPRINKLER/SUPPRESSION 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 fhis permit musf comply with <br /> current federal,state,and focallaw.The granting of a permif only authorizes approved work and no deviations therefrom.Deviafions must first be authorized in writing from the <br /> Building Official beiore being authorized under any circumstance.I am the owner,or I am aufhorized by the owner of this property fo perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC, <br /> City of Evereft Official Use Only <br /> ERMIT# <br /> ��____�� � 2 r � �' «'O -- 25 <br /> Owner/Authorized Agent Signature Da e ( vised 9/23/2016) <br />