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BUILDIIVb)04E-fr PRMIT APPLICATI 1- <br /> MECHANICALS PLUMBING I SIGN /SPRINKLER/ DEMOLITION <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 I www.everettwa.gov/permits <br /> (Blue or.Black Ink billy Please) F PROJECT SITE INFORMATION , <br /> PROJECT SITE ADDRESS: 020/?,( /4/i ' dz/6 9‘S--;z9/ PROPERTY TAX#:yQ/Lf ///[��/ a7;..._ <br /> LEGAL for new construction: Short Plat/subdivision Lot No.'/0 (attach copy of long legal description) <br /> _ <br /> CONTACT-INFORMATION <br /> OWNER NAME: (0367" Qcet4 0TENANT NAME(If Commercial): <br /> OWNER MAILING AD RESS: STREET /7/2?/1/ 5.t <br /> G s `� <br /> Z �/S STATE 49/U/O ZIP <br /> OWNER PHONE: X2' CO 4'44'a- I./4.r?)� OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT:6NER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: Vy/43 CONTACT PHONE: aloe 7 <br /> CONTACT EMAIL: /7S—k-6/71-1e,..0 /.4/1/0.e;/ C.0rv1 <br /> BUILDING PERMIT APPLICATION` <br /> Existing Use of Building: Contract Price of Work:$ (t 006 <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR- etached ) �,,,4-A ched ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: !,,Rad ❑Addition Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WOR(: <br /> d d 3 6C /J /o 0,ia / 5,7/7'_vG I v ve___ <br /> N = Mala -Of rsc /5 Q s/2„._o64-A At_el- <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 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 /> lExhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wit State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> O, ,• A or' a gent Signature Date (Revised 5/20/2016) <br /> �7 <br />