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� PERMIT APPLICATION� <br />BUILDING / MECHANICAL / PLUMBING / SIGN / Sr�F21NKLER / 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 � wwvd.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: PROPERTY TAX #: <br />,�E 1L� �r.E� � w s� �•� z�� ?�fi0 0 2 00 3 o t 2 v� <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: 'j �f} w ' � � � � � TENANT NAME (If Commercial): � ��}GU � <br />OWNER MAILING ADDRESS: sTReer 1�o iC 00 S <br />cirr �f�l�E2-(N E STATE Wk ziP 6 <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTORNAME: VQifU��j(7 lC1CZ--�r`�T`RpC7a S �lIJC. <br />CONTRACTOR ADDRESS: srnEEr �� 6�� � i"i-F � vJ��'i <br />CITY M� Kc L-�o STATE �1�J� ZIP � V��- 5� <br />CONTRACTOR PHONE: �O6 �C{ �-(qOa CONTRACTOR EMAIL: f�Rl�� v(lJl C �• C O n�. <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: O OWNER CONTRACTOR O OTHER (Please Specify) <br />CONTACT NAME: � E �(Z/?-J' CONTACT PHONE: Zp�j (�L} 3 D�(' ``j"3 <br />CONTACT EMAIL: v��''� � :I/v`- �.L. C�"'�- <br />BUiLDING PERMIT APPUCATION <br />Existing Use of Building: �t'�t C� Contract Price of Work: $ Z`� ��'3 . O� <br />Proposed Use of Building: ��< <E Heat Source: O Gas Electric O Other <br />Building Type: O SFR-Detached O SFR-Attached O Duplex O Multi-Family-# of Units: Commercial O Industrial <br />Type of Project: O New �ddition O Remodel O Repair T.I. O Sign O Sprinkler O Demolition O Change of Use <br />DESCRIPTION OF WORK: <br />'S��PC�(..EM�'N TArt- CpOI.W C> i}iQ� ITZ OI`s �CZ- CO N�E'/LCl�' C E—� P��Oa/�1 ON <br />GE� �– 2. �('�'- f,k,,MP �.�►c u. �i2.o.c c o� Cooc..w G S u!'Po 2t— � '1?t�- <br />�2�,+cw s Sysr�-. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICA[` PERMIT APPLICATION <br />Type of Project: _New Addn � Alteration _Repair <br />Fixtu es List of Fixtures Fi�ctu es List of Fixtures <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 />�� �� � � PLUMBIN����PERM�T APP.I��(CATION�� � � � � ��� <br />Type of Project: _New _Addn _Alteration _Repair <br />Fixtures List of Fixtures Fixtures List of 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 correct. Work done pursuanf to this permit must comply with <br />current federal, state, and /ocal law. The granting of a permit on/y authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building O�cial before being authorized under any circumstance. I am the owner, or 1 am 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 W,4C. <br />City of Everett O(ficial Use Only <br />PERMIT # I � � � r� J `,.,�1 <br />V % l/ l�l <br />(Revised 10/12/2015) <br />� <br />y �. <br />