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PERMIT APPLICATIO <br /> BUILDITa�� : MECHANICAL/ PLUMBING /SIGN i �i'RINKLER/ 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: f-� q ;,�,i L VZ:►' �'r e �, (,�-c�, PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): � - r= <br /> OWNER MAILING ADDRESS: sTrzeEr <br /> cilv sTnrE zia <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: � ►�k I �I ►� � =t V�CG� <br /> CONTRACTOR ADDRESS: srReEr I(C 2�Z � Ut�1��I— Lv�i c-"� H�•=' � c��P <br /> ��n I���<< cae�►� STATE yV �� zP � c��2 <br /> CONTRACTOR PHONE: HoZ''j. 33('' . �I L C�' CONTRACTOR EMAIL: ��I'fi.SiC ilS �-'/�^1J�1 C.cTl�1 <br /> CONTRACTOR LICENSE#(REQUIRED): (, } � -��.�� ��C)���` CITY OF EVERE'iT BUSINESS LICENSE#(REQUIRED): �rj j�O . <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: f;�-��� CONTACT PHONE: ?�=25 �'��� �� I� L' <br /> CONTACT EMAIL: ��,—j-�i C r15 �� l))j�l CL')ti� <br /> BUILDING PERMIT APPlICATION <br /> Existing Use of Building: '�y �l Y Contrect Price of Work:$ �' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑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 /> ��1`�fi��l�� �� Ll��.,�����1 l�+i�r- c��,��,lc��� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn _Aiteration _Repair <br /> #of List of Fixtures #of List of Fixiures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures 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 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 Iaw. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> 8uilding Official before being aufhorized under any circumstance.1 am the owner,or I am authorized by fhe owner of this property to perform the work for which appiication is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> `� City of Everetf Official Use Only <br /> � �,+ �J � �i l � PERMIT# ��� � � <br /> O n o zed Agent Sign ure Date (Revrsed 9/23/2016} <br /> I ,� <br /> �� <br />