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PERMIT APPLICATIC <br /> BUILD MECHANICAL/ PLUMBING /SIGI"H41PRINKLER/ DEMOLITION <br /> iooll°°:1111PHIV—A <br /> 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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Z 2 uV t L Po U AUL PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: \J a vt; r/0 L L TENANT NAME(If Commercial): 4( q SP r 1.4".,1") <br /> OWNER MAILING ADDRESS: STREET f( o N et, J cAQ�jtr (/v etc, d D 7o-5 <br /> CITY pv'Q„rQ/��' STATE LAik ZIP I���' L� 7 <br /> OWNER PHONE: 1-i Z 5 •3Z 1 - \2 3j OWNER EMAIL: 0(a Pt:4/1 - 3o Z <� (J .1`K f+S�5 , (0=� <br /> CONTRACTOR NAME: — 1 1 cc hit 4,t4 54-i I I <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: (1 ZS 43 3©- ert CONTRACTOR EMAIL: ilAav-C VL 1A W-04�`2� ( (JWt(.(454- V1 PX <br /> CONTRACTOR LICENSE#(REQUIRED): JCC(,{ <br /> ‘12.‘ 9 1 ) QV CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OS3.yT3 <br /> PRIMARY CONTACT: OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Z j. 3z,, , I z 35 `nom' <br /> \/ a t (/A , o 1`� CONTACT EMAIL: �dh,c 1 < ' `" <br /> 11f bCDT 4- S-,VA5.t 0Azt <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 3 12 Z <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. T1ign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WO(RK:r\ r� /� (� r ', • ,i <br /> MA 6 lWv0Dv�L �► U>�I.d�N�/XI tr <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/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 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.lam the owner,or lam 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 /> PERMIT#�no)y ,ten <br /> O Agent Signature Date (Revised 9/23/2016) <br />