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�ERi�d9T A6�4��.BCA�'IO�I <br /> �&39L�9�� /i�i��F6ANICAL/ ��,lJ��ll�� /SlG� /S��BY��a�.ER/ �EY�&OL.➢�'IOP� <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 /> ��Baa��a��9�e� 6a���av�}��9e�se) ����9��°�'�1�'� 1�9�'��9l�A`�'��Q� <br /> PROJECT SITE ADDRESS: �� (� � , �:� � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> COtd7'AC`� 1�8��R11�14°�9��! <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWiVER MAILWG ADDRESS: s-rReEr <br /> � C�'ry ' . STATE � ZIP � <br /> OWNER PHOPJE: OWNER EMAIL: <br /> CONTRACTOR NAME: �j`j)����!J <br /> CONTRACTOR ADDRESS: s-rReeT u <br /> CIN STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR L(CENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICAT'IOPI <br /> Existing Use of Building: Contract Price of Work:$ �S� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> (�-�i� , ��1 ��t/ -� C�� . � . <br /> � <br /> ASSOCIATED BUILDING PERMIT#(if appiicable): <br /> MECHANIGAL PERMIT APPLIC�4TION PLUMBING PERMIT APPLlCAT10N <br /> Type of Projecf: _New_ Addn Alteration _Repair Type of Project: _New _Addn AlteraYion _Repair <br /> #of Lisf of Fixtures #�f List of Fixtures #of List of Fixtores #°f List of Fixtures <br /> Fixtures Fi�ctures Fixfures Fixtures <br /> A/C—Air Handiing Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) DrinkingFountain <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 /> Clofhes Dryer Hookups j Other: �^�o� Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKL.ER/SUPPRESSIOtd 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 granfing of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be authorized in writing from the <br /> euilding Official before being authorized under any circumstance.l am the owner,or l am aufhorized by fhe owner of this properly to perform the work for which application is made, <br /> and I comply with the Stafe Contractors Law 98.27 RCW and 296 200A W,4C. <br /> � Cify of Everett Official Use Only <br /> �/' f PERMIT# <br /> i��F� / /�.�� �����i �� . Q <br /> � <br /> O er/Authorize gent Signature Date (Revised 9/23/2096) O^ O <br /> � � �� V J <br />