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PERMIT APPLICATION <br /> BUILDI LIIECHANICAL/ PLUMBING I SIGN ' WINKLER/ DEMOLITION <br /> 4E77- CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please)rr�� PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: poo;_. DO 1,LC- Ave_, PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ` CONTACT INFORMATION <br /> OWNER NAME: �(N 12\f)' <br /> , \ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET At/ '/ %4 l a()a O( I Ce S j(J-L <br /> CITY C'V e,' V STATE WA- ZIP 6\ A L <br /> OWNER PHONE: 421/5- l to D- g-0.10.) OWNER EMAIL: p\'11 'r l \1 0 VAS V\ . (A v\ <br /> CONTRACTOR NAME: ?r1)\vVl `(/t-E <br /> CONTRACTOR ADDRESS: STREET <br /> CITY X f STATE ZIP <br /> uCONTRACTOR PHONE: Oic - , -3T--• U -"C/ CoCONTRACTOR EMAIL: (0,01(13 <br /> CONTRACTOR LICENSE#(REQUIRED): k " ) 1.--1(Y\Si ( Q D 5 ��L6 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):S�J 6 a <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N• E: CONTACT PHONE: 1)1/S--'7(,,0-- 0cb <br /> �.„ 4, ?`/1111 6,0S CONTACT EMAIL: On�\\I ,1\-e WAS Vl . (.61/`x\ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ CJ)0. <br /> °-1)--- <br /> Proposed <br /> DProposed 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.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <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 #of List of Fixtures #of 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 I SUPPRESSION SYSTEM <br /> Chemical or Water I 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 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> V-1 <br /> PERM j rip <br /> - .0 (.1 <br /> I Ir�/IIJ( <br /> Owner/Authorized Agent Signature Date • (Revised 9/23/2016) <br />