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PERMIT APPLICATI <br /> BUILDr MECHANICAL/PLUMBING /SIG�RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue`or Black Ink Only Please) PROJ T E INFORMATION <br /> PROJECT SITE ADDRESS: //a,� �,�•�j�'j U PROPERTY TAX#:O�6 OQ'D�'7,3 rfOD <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ' <br /> OWNER NAME: m �/V((,ts' TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReer /D�o� � U e.- � '-' � I <br /> CITY �v e�""� STATE ZIP Bp�Q <br /> OWNER PHONE: — 3^� � OWNER EMAIL: ��� � � � <br /> CONTRACTOR NAME, � <br /> CONTRACTOR ADDRESS� Q STREET � � <br /> CITY `"' STATE ZIP ��,�� <br /> CONTRACTOR PHONE: p?g0-l3I Q CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ,�'OWNER ❑CONTRACTOR ❑OTHER{Please Specify) <br /> CONTACT NAME:mqR� ��/�f�(,�S CONTACT PIiONE: �Ia�"� �73- � 7g <br /> CONTACT EMAIL: /Y� D � � � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �, Contract Price of Work:$ <br /> Propesed Use of Build:ng: Heat Source: ❑Gas Flectri� ❑O;hsr <br /> Buiiding Type: FR-Detached • ❑SFR-Attached ❑Duplex ❑Multi-Family�of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑D molition ❑Change of Use <br /> DESCRIPTION OF WORK:C���(� ���� , +-p�J �t. � e <br /> ASSOCIATED BUILDING PERMIT#(if a licable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New Addn _Alteration _Repair <br /> #of Lisf of Fixfures #of List of Fixtures #of Lisf of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixfures Fixtures <br /> A/C-Air Handiing 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 Medicai Gas <br /> Range Hood Water Heater Other: <br /> Exhausf Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water 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 Ioca!law.The granting of a permif only authorizes approved work and no deviations therefrom.Deviations must firsf be authorized in writing f�om the <br /> Building O�cial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this proper(y to pertorm the work for which application is made, <br /> and 1 compiy with the State Contracto 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � IT <br /> �-- -� 3 - �� <br /> Owner/A ize e Signature Date (Revised 9/23/2016) <br /> �/(r <br /> �� <br />