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PERMIT APPLICATION <br />BUILDINC•'IECHANICAL / PLUMBING / SIGN�RINKLER / DEMOLITION <br />�� r�G- 2��;� � CITY OF EVERETT PERMIT SERVIC �L..� <br />� 3200 CEDAR STREET, EVERETT, WA 98201 `'�v'?j �� / <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: J��' � l��� r r_ +�^ �,v.�� PROPERTY TAX #: �� �. ����% ('� �'.� U i-����y <br />1 <br />LEGAL for new construction: Short PlaUsubdivision !-�r� �,'k Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: jCy;� aii'`--•i`- )-?:'� j°r iC, �. TENANT NAME (If Commercial): �� �+�p�j �''�`7zs `s . <br />OWNER MAILING ADDRESS: sTReeT �'1 � y�`� � ���,=: -��� � �;;�„ <br />CITY ,"�_� f�-�`� STATE � ZIP ;� J <br />OWNER PHONE: 7J ���- OWNER EMAIL: ,,R-� ���} <br />CONTRACTOR NAME; �' �; - �"j';� ,�-�=-�--- � - ��. <br />CONTRACTOR ADDRESS: sTReeT .. ~�' , i�j f xyC '�j � � <br />�' � - � <br />CITY -�h..��" 1 1� j-�.- STATE ��`I ZIP �+3 <br />CONTRACTOR PHONE: LLG`"' ��' I'" (.�'�i� CONTRACTOR EMAIL: ��i�I� �Z�' `��� "��I'"! Y���Ckt�l^Pi�jr(!'-r�, L;� <br />CONTRACTOR LICENSE #(REQUIRED): � �r� � i� J-(�{ ���1 �:- CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): Or ��� <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � �'. ' � yC�' <br />�i. E:' � .�`C�.i _lj .,� _� I .� <br />�3 � ��Vli °� �� C.y� CONTACT EMAIL: , � ,!a� .., . � ` ._ ,• --- � - <br />�� � F,�� ,7 0� r-r'i�r11r C Hfi�i� i C��.. . C t� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ %�� ��3Cy'� �'�, <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: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�i' � t� i. l�.�fi.5 ► iN'C; �'� l�L�t_.- i� c:.��c�' _.�.,Z i�y� °i�,� i C..t��2.�'itL� 6.� c'Cw"�l�+ii7� F._.t.��-r-, <br />;- / te <br />io7 ,� .�� /�,;,�,� -'Z ,�` ("��.��i=-.,�.:�rN�� 4�rU i�T� d s �� �� �� (;.�-) ; C�2... <br />L11t-i� -- �'`' ;�-' �-11c G . ��' m - — — --- - ,-.- <br />ASSOCIATED BUILD`♦ Is G PERMIT # (if applicable): � ��� C��`� �;� � � '�� � �C�� (2�' ��`z��~— � <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration Repair Type of Project: _New _Addn _Alteration _Repair <br />#of #of #of #of <br />Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: 1 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 I am authorized by the owner of this property to perform the work for which application is made, <br />and 1 complv.rvlfll�the State Contctctors Law 18.27 RCW and 296.200A WAC. <br />C.�.�""��^ �� <br />Signature <br />City of Everett OKicial Use Only <br />PERMIT # <br />� � 2;� i � ;� � � � ,� � J <br />Date (Revised 10/12/2015) <br />