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PERMIY APPLICAI"Ili. <br /> �UIL� � / fI�lECfiANICAL/ PLUilfi�li�G /�IG:�:�PRINKLER/ DCIViOL.IT'IORI <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 /> (�lue or�lack Ink Only Please) PROJECT�ITE IRIIFOi2MA'i'901P7 <br /> PROJECT SITE ADDRESS: 3 S�5 �/'� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long Iegal description) <br /> CONTI�CY INFORMATION <br /> OWNER NAME: �ar k � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREET <br /> CITY " STATE ZIP <br /> OWNER PHONE: Ot�ilNER EMAIL: <br /> CONTRACTOR NAME; �� <br /> CONTRACTOR ADDRESS: sTrtEET '$$� £Jt <br /> CITY STATE �J ZIP ��ZJ <br /> CONTRACTOR PHONE: �"J.ZS- (fl(O ' �D � CONTRACTOR EMAIL: , � S �' , <br /> CONTRACTOR LICENSE#(REQUIRED): (�J 3 .• � - ZS` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER '�CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C�,ZS- (o �� ^ �ZQ'� <br /> � Q` k� CONTACT EMAIL: k, s <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �/(, - Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric Q(Other �a <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex �Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel �Repair ❑7.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: t 'J � <br /> �no�i�:d�c� 31a"�e� 5�'k.�"t d►`� -tb eac.�'t c.V�i"�.�, ���. , !-�`� i � �?. ! 1� �� � /t i?� I 2,J <br /> l.l 1 , 122 , ��� <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 _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures ��f List of Fixtures #of Lisf of Fixtures <br /> Fixtures Fixfures Fixfures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Sysfems 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: ,S J <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 comp/y with <br /> current federal,state,and local law. Tl�e granting of a permif only aufhorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officia!before being authorized under any circumstance.!am the owner, or 1 am authorized 6y the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> Cify of Everett Official Use Only <br /> PERMIT# � <br /> r �_ . L____ " �I- 3- I-7 � ! �l 0 �,r.� � �;��- <br /> Owner/Authonzed gen Signature Date (Revised 9/23/2016) <br />