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PERMIT APPLICATIO <br />BUILDINC�ECHANICAL / PLUMBING / SIGN 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 />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS:l.�f j ��.y,��i � �, � ��,- <br />� -w . _ <br />LEGAL for new construction: Short Plat/subdivision <br />PROPERTY TAX #: <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �'�( � ,'� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTaeeT�j 7i'�-4' ��L, � �,�� %�/�- <br />1, [� (ti,,_1 <br />CITY ��(/��.- � STATE (�4�}r l ZIP [ ti v� i-�l <br />OWNER PHONE✓� I"��G1--(;lL � � OWNER EMAIL: <br />CONTRACTOR NAME: �� 1��+ �JC,{_YVt_Z� <br />CONTRACTOR ADDRESS: sTaEET �( I � v%'LT'" S"fi �� �} <br />CITY M vV` {�-"�,� � I��% {�G--t. („�C STATE GL�� ZIP ! C/uL"( � <br />CONTRACTOR PHONE: � ���� � � I ' � ( 3 CONTRACTOR EMAIL: ��� ��! i,(�' %(,[�� ����� L i:lV) <br />CONTRACTOR LICENSE #(REQUIRED): I'� �J 1� �' }" �V t✓ �� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): US2� � V <br />PRIMARY CONTACT: ❑ OWNER �l CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ' � � _ �• j � - � � � G <br />— Uvi I Gi� � F�.- ,�11 G l/1 1� CONTACT EMAI L: 9..j1-�(� �' I � � l-L('� �\ /� -�.C-4�>VV�� ;�liY�f -C-` YJ-^, <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ ��'� �� .� <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 />�� C'� %�" �' �l ✓V� �' G� i/1 � 1 �ln ✓!n �1 � I v� � t-� i � j <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 List of Fiartures # of List of Fixtures # of List of Fixtures # of List of Fixtures <br />Fintures Fixiures Fixiures Fi�ctures <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 ciicumstance. 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 i8.27 RCW and 296.200A WAC. <br />Agent <br />��� i o�--� � i� <br />Date <br />City of Everett Official Use Only <br />PERMIT � <br />�l b�� � <br />(Revised f 0/12/2015) <br />