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VIIIIII II II PEF'MIT A PPLIC.ATI <br /> UILDt 7."1 MECHANICAL I PLUM) ING I SIG;III . —,RINKLER/ DEIVII®LMON <br /> ' moi 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 /> ( laze or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ate ( 3 J v ork icve. `w A— PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> Ct QeI7IACT INFORMATIIIN <br /> OWNER NAME: � L c TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Qty, <br /> CITY STATE ZIP <br /> OWNER PHONE: (gL((e---"1-S- -L,.'3 3Z Ic OWNER EMAIL: S,g t_,6yvN) <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: ST <br /> CRY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: ; <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: L9�bWNER ❑CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C(✓( te `�� —4? -D_I-1— <br /> CONTACT EMAIL Ui 'u �03y c-esT►-, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ I 16849 <br /> Proposed Use of Building: • Heat Source: )Gas 'Electric )Other <br /> Building Type: L SFR-Detached ❑SFR-Attached )Duplex )Multi-Family-#of Units: )Commercial 0 Industrial <br /> Type of Project: )New )Addition )Remodel )Repair DT.1. ❑Sign )Sprinkler )Demolition )Change of Use <br /> DESCRIPTION OF WORK: �.�,;; _ ' 'Gli' , td,wa, — t,c,.S�—r 1�(�c.r <br /> cLG '-isi✓'7"J'leNo'i - r rS ^��U\ i)-'1C) <br /> I l <br /> \,, w,,, ii; yam,.,. .1--c3 r f� n,Ap {,,(� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): 1 <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration . Repair Type of Project: _New Addn Alteration 'x 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 I 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 f 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 /> SPRIIRIKLER 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!am authorized by the owner of this property to perform the work for which application is made, <br /> andI mply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> (a/ /r PE ��� <br /> Owne t rized Agent Signature <br /> Dat <br /> e1 (Revised 9/23/2016) <br />