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t PE"MIT APPUCATIO <br /> BUILD6 ) MECHANICAL. PLUMBING /SIGN RINKLER DEMOLITION <br /> „ ,,ligCITY OF ES <br /> 3200 CEDAR STREET,EVERETT,WA EVERETT PERMIT SERVICES <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blare or Black Ink Only Please) PF CAECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: v�� t 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: OWNER EMAIL: <br /> l •R.,.1....CONTRACTOR NAME: .DT'-� /4/(/ Aagt ' 7ll • ,L� <br /> —A/lf-4•S V 4-1:-C-- <br /> CONTRACTOR <br /> C-CONTRACTOR <br /> ADDRESS: STREET 2Z tZ2 !3�r /V <br /> -,�r• CITY/ go ... "i. STATE [A ZIP / aAi <br /> CONTRACTOR PHONE: 2I:irPI;J ((® CONTRACTOR EMAIL: axial: fie4- <br /> CONTRACTOROR 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:$ hi—i00.� <br /> � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> wilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial <br /> pe of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> x D SCRIPTION OF WORK: R cmext Qii 6i--) <br /> V01,1/M1Y ga-C4C-- it kieiAG. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 9)110 82� <br /> /4- 'Poi( e, <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 /> NC-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 /> Bu'din•Official before bei .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 co'ply with the Sta=Contractors Law 18.27 RCW and 296.200A WAC. <br /> �[ f/! City of Everett Official Use Only <br /> 1` 4r 1j/l <br /> / I� PERMIT#,n it a( O2_o <br /> _,.__:, <br /> Own r/Au •rized A.ent S !nature Date (Revised 9/23/2016) <br /> I' 1 ---") <br /> Z <br />