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PERMIT APPLICATIDN <br /> gUllDING 1 MECHANICAL t PLUMBING/SIGN/SPRIN KtER/ QEMOLITION <br /> CITY OF EVERETT PERMtT SERVICES <br /> 3206 GEDAR STREET,EVERETf,WA 98201 <br /> (P}425-257-8810 � FAX 425-257-8857 �(E)everetteps a�everettwa.gov� www_everettwa.gov/permits <br /> {Blue�:or Black tnk t}nly Pl�a�e) � PROJE�T SITE 1NFORMATIt?N�� ��� � � � <br /> PRQJECT SITE ADDRESS: � , � ..�V PROPERTY 3AX#: <br /> LEGAL for new constniction: Short PlaVsubdivisian Lot No. {attach copy af long lega3 descriptian) <br /> GONTACT INFORMATION <br /> OWlVEft NAME_ \" TENANT NAME(If Commercial): <br /> OWfVER MAILItVG ADDRESS: sraeer �12.. �a,` Y.� V <br /> C1N STATE ZIP ( <br /> OWNEi2 PHONE: ` - - tQ lg OWNER EMAIL: � 1 I I •I �lC� C� '��J Y ' <br /> CONTRACTOR NAME: ` �, � '� � <br /> CONTRACTOR ADDRE55: s-rRer-r � � <br /> c�Tv � STATE zi� � <br /> CONTRACTOR PHONE:2 - �Q " � CONTRACTOR EtNAIL: � �� �(,� �� �C <br /> CONTRACTOR LICENSE#(ftEQUIRED): CITY OF EVERETT BUSiNESS l.fC�ENSE#{REQUIREU):�� � <br /> PRIMARY CONTACT: ❑pWNER �CONTRACT�R ❑OTHER(Please 5peci#y) _� <br /> COI�TACT NAME: CONTACT PHOAiE: �-�(��'-�— � � � <br /> �t\�`�� �� O� CONTACT EMAIL: � � ,�� <br /> BUILDENG PERMtT APPLICATION <br /> Existing Use of Building: Co�tract Price of Work:$ 4'"T <br /> Proposed Use of Building: Heat Source: Gas C�Electnc ❑Other <br /> Buildin T e: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�#of Units: ❑Commercial �Industrial <br /> Type of Project: f�New ❑Addition ❑Remodel ❑Repair �T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ����� ��� �;� �� ��� <br /> � � <br /> ASSQCIATED 6UILDING PERMfT#(if applicable}: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Praject: _New _ Rddn 4�AItQ�"dYFOR Repair 7ype of Projecf: New ,_Addn _Alteration i2epair <br /> #of tisf of Fixtures #�f List of Fixtures #�f lisf of Fixtures #of List of Fxtures <br /> Fixtures Fixtures Fixtures Flutures <br /> AfC-Air Mandling Units Heai Pump Toiist Backflow Preventer(Inside B1d ) <br /> Forced Air 5ystems Unit Heater Bathtub Urinal <br /> Gas Piping 8oiler Lava#ory(Wash Basin} Drinking Fountain <br /> Water Fteater Refrigeration Shower �loor Drain <br /> Gas Fireplace Woad Siove Kitchen Sink&Di�posai Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes D er Nookups Other: Clothes V`Vasher Medical Gas <br /> Range Hood Water Hea#er Other: <br /> Exhaust Fan Sink{ServicefBar/Mop/etc.) Other: <br /> � <br /> SPRiNKLER(StlPPRESSIdN SYSTEM <br /> Chemicai or Water No.of Heads <br /> ACKN�WLEDGEMENT:i have reviewed this application and co�firm the informaGon confained herein is true and correct. Work done pursuant to this permit must cnmply with <br /> current federa/,sfate,and local law.The granting of a permit only authorizes approved work and no deviatrons therefrom,DeviaUons must frrsf be authorized in w�ritinq from the <br /> Buiiding O�cia!before berng authonzed under any circumsfance.1 am the owrler,vr!am authorrzed by the awner of this property to peifnrm ihe wwk for wtrich application is made, <br /> an mply with the State tractors Law 18.27 RCW and 296.ZOOA WAC. <br /> � ` Gity of Everett O�cia!Use On�y <br /> / � ( PE I ` <br /> � �� � o � <br /> � � z <br /> wner/ orized Age i Date {Revised 9123I2016J <br />