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BUILDIN(� � MECHANICALE P UMBING CSIGN I+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.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION_ <br /> PROJECT SITE ADDRESS: Cp(y7 � �1�'f��- �7pcl � #r'JD PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer <br /> CIIY " STHTE ZIP <br /> O1IVNER PHONE: OWNER EMAIL: <br /> CONTRACTORNAME; pjg�� SI h Q�VIC2S <br /> CONTRACTOR ADDRESS: sTaE� � � - �/Q«H �� <br /> CIIY �1 STATE �C ZIP � Q�I� <br /> CONTRACTOR PHONE: ��Z.'Jr. ?j�Q, g�(p Q CONTRACTOR EMAIL: �j "r'S� Ifl S M s(1•GO�'Y� <br /> CONTRACTOR LICENSE#(REQUIRED): ��5� -�q Q'{� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): (��j�j Q� <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: 'FY'AY1K CONTACT PHONE: 1�2,� ,33 v. S f bO <br /> CONTACT EMAIL: b�g�(7�n$@Ms n• CO(Yl <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Cp►'n r Contract Price of Work:$ �9 �g <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> ` Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> t��ta I l C�) UEt) G�annc,► l�r d�s�P�ay . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> _ _ _ _ <br /> MECHANICAL PERMIT APPLICATION'' PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #°f List of Fixfures #of Lisf of Fixfures �°f List of Fixtures #�f List of Fixtures <br /> Fixfures Fixtures Fi�ctures 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/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this applicafion and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federal,state,and/oca/law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> �`�� ' ' "') PERMI�I l �� /�v <br /> � <br /> Ow r/Au orized Agent Si ature Date (Revised 9/23/2016) <br /> M <br />