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. PERMIT APPLICATIO� <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / 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 />PROJECT SITE INFORMATION <br />PROJ CT SITE A DRESS: PROPERTY TAX #: <br />r: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />, � <br />OWNER NAME: TENANT NAME (If Commercial): � <br />OWNER MAILING ADDRESS: sTReer <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: � r <br />CONTRACTOR ADDRESS: sTReer <br />CITY STATE ZIP � <br />CONTRACTOR PHONE: — �— � ,S CONTRACTOR EMAIL: J ` . � � C <br />CONTRACTOR LICENSE #(REQUIRED): Z CITY OF EVERETT BUSINESS LICE #(REQUIRED): �yLf <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: "- z t-.� 7s Cc�?� o <br />�u ,�� � CONTACT EMAIL• � �� � � �` � <br />BUILDING PERMIT APPUCATION <br />Existing Use of Building: Contract Price of Work: $ , D'0 <br />Proposed Use of Buiiding: Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industriai <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: �G�V.e 5 iY1p�(E �./C r O� �PQM (��mbr�ne ��'ns-I�.i! 5; ��e �0.�/Cr O� �l�'� <br />(�en5 �ec�. M�chw►= ca(l �+04,� J� S�r� le �C, e� e E-' 6� N�•l� 11� Me v✓� b ra � • <br />�,� ,� y n� r�e���:�� y <br />z0.l�a� j�1c���a"I War/'e.�t%� ��kned% <br />ASSOCIATED BUILDING PERMIT # (if app(icable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixfures Fixtures List of Fixfures <br />A/C —Air Handling Units Heat Pump <br />Forced Air Systems Unit Heater <br />Gas Piping Boiler <br />Water Heater Refrigeration <br />Gas Fireplace Wood Stove <br />Gas Range Ducting <br />Clothes Dryer Hookups Other: <br />Range Hood <br />Exhaust Fan <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures <br />Fintures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT.• I have reviewed this application and confirm the information contained herein is true and correcl. Work done pursuant to this permif must comply with <br />currenl federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefiom. Deviations must first be authorized in writing from the <br />Building Official be%re being aufhorized under any circumstance. I am the owner, o� I am authorized by the owner of this property to perform the work fo� which application is made, <br />and I comply with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br />uthorizec4�Gcfent Si�nature <br />Date <br />City of Evere[t Of(icia/ Use Only <br />PERMIT # f� � �•�I �\, j ,� <br />�li, %L'� � J <br />(Revised 10/12/2015J ,`j Z <br />( <br />