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PERMIT APPLICATION <br /> W LIILDIl'IG I MECHANICAL( PLUMBING /SIGN PRINKLER I DEMOLITION <br /> milit 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) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: Q8211 u. CAS MD 15t,A. PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision ✓\ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: . 'f ) /� OWNER EMAIL:• <br /> / <br /> 4 CONTRACTOR NAME: 'R• Llil/ 1�4G/111ry Y i Zfiaa V Ut— <br /> CONTRACTOR ADDRESS: STREET 223 /14' f <br /> _-• CITY , <br /> , .Y 1, STATE W A /y]ZIP / a�� e <br /> CONTRACTOR PHONE: Z 1%l 4, CONTRACTOR EMAIL: C-h`1 ijfs (i) <br /> CONTRACTOR LICENSE REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 2-WO UO <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other <br /> wilding Type: DSFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial Dlndustrial <br /> pe of Project: DNew ❑Addition DRemodel DRepair DT.I. DSign DSprinkler DDemolition ❑Change of Use <br /> x D!}S0CRIPTION OF WORK: -C is cAext Qiitc- s <br /> r'tio <br /> 2 at,(14f0 Ilk ilf- Tis1/21( k: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1-10`2..-•UlLi <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 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 /> curr-•t 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 /> B ldln• Official before bei •authorized under any circumstance.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> a •I co 'ply with the Sta<!Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �. PERMIT n 0 62 <br /> Ow •r/Au •rizedA•entSi.nature Date (Revised 9/23/2016) <br />