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PERMIT APPLICATION <br />BUILDINC�IECHANICAL / PLUMBING / SIGN �RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICE <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 />CONTACT INFORMATION <br />OWNER NAME: � �, � � �Q�� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREET �Q R,Z,C; I'�j �1G L <br />CITY �, 1/,�: '� � I STATE V�J l � ZIP <br />OWNER PHONE: �i�,, S ' %cS,�- � <br />CONTRACTOR NAME; _��Fje.� <br />CONTRACTOR ADDRESS: srReer <br />CITY� <br />CONTRACTOR PHONE: �?.c��S; <br />CONTRACTOR LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER � <br />CONTACT NAME: <br />/� — - - , AI r ._. ._ <br />OWNER EMAIL: <br />� ���� s <br />�SrG c�r,� �2 � <br />STATE <br />ZIP <br />' � CONTRACTOR EMAIL: <br />�S � J� CITY OF EVERETT BUSINESS LICENSE #�REQUIRED): <br />CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: �zs ��� � C�/��� <br />/ (��' � CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ �6�a� � <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 />�. � �-O�'� �Lp �L p f= T'� �� S �-'�-TC�� /Z- <br />IATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fi tu es List of Fixtures Fixfures Lisf 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 />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures <br />Fixtures 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 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. 1 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 comply with the e Contractors Law 1 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />, PERMIT # <br />//'�� /�S �1 '' <br />Owner/Auth rized Agent Signature Date (Revised 10/12/2015) ;'� <br />`� �J � J , �-�'` <br />