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PERMIT APPLICATIO <br /> BUILDINCti■IIECHANICAL/PLUMBING/SIGNRINKLER/ DEMOLITION <br /> OLT <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 /> (Biule or Black Ink C!' <br /> hIy Phase) � .PROJECT SITE INFORMATION- ;: : ;; . <br /> PROJECT SITE ADDRESS: 37,2.K 9-y-.diory> -e )O 1 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision / Lot No. (attach copy of long legal description) <br /> FONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): CEM fes^1 wot 14 (jy,, , <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: 5 <br /> CONTRACTOR ADDRESS: STREET /q In 6 u col qct 3f A <br /> CITY /-7i7)96)00/4 in� ZIP y /< <br /> �ri7hWt�u/A )V� �+ <br /> CONTRACTOR PHONE: 42A-----.2_77 __o0 ey 2-- -CONTRACTOR EMAIL S a /�GJ -S S-c,,,, <br /> CONTRACTOR LICENSE#(REQUIRED): .des 4 CITY OF vERETT BUSINESS L CEEH EE##(REQUIRED): �— <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4_.S- -___2j ,--00q 2-. <br /> Ta/Me3 pY)C— CONTACT EMAIL: ea -vj 'i , rr <br /> a BtUIo1NG:PERM T ADPL CA "IO$ .. <br /> Existing Use of Building: Contract Price of Work:$ .IWO—.- <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ---Cr'Fad( camel►A e I Lc L--..s4,4-Et. <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 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/n writing from the <br /> Building Official before being authorized under any circumstance.I am 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# <br /> `-- - /0—/a--/,9 St 310- 603 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br /> (1- <br /> /� <br />