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PERMIT APPLICATION <br />BUILDING•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 />CONTACT INFORMATION <br />OWNER NAME: !V�-�, r^ TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT �� ' <br />i <br />CITY _ STATE ��'� ZIP � � �� t <br />PHONE: �t .�1 `� — <br />ONTRACTOR NAME; (J�� ., <br />ONTRACTOR ADDRESS: sTReeT <br />CITY <br />ONTRACTOR PHONE: "[,��J �—jj� ( <br />ONTRACTOR LICENSE #(RECIUIRED): � <br />RIMARY CONTACT: ❑ OWNER �C <br />ONTACT NAME: . <br />rYl.�,�'..�C�� �� )'� i�C'C.��' <br />ER EMAIL: <br />L_� ` <br />STATE v ZIP <br />U CONTRACTOR EMAIL: �+F' � �-}� � . � <br />1 i'U��(„�%'1 t'l d 7�(� 1'� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />ITRACTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: , � a �� G `� � <br />C� CONTACT EMAIL: �i�,���.�—� � �;�^�� , �; �-y-� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ t��.p . d� <br />Proposed Use of Building: Heat Source: �Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached �QI7SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel C�,tepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�d'15�- � Y�c��u..+��' ��5 � t�� Y� i.�x�'� -�-�� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration �Repair <br />Fixtures List of Fixtures Fixtures 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 />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration �o 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 i�eviewed 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 O(ficial 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 State Con6actors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Officia/ Use Only <br />, '� PERMIT # <br />" � ��� I� � bz� � <br />Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br />