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� PERMIT APPLICATION• <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / 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: .-,t! �� � P PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />OWNER NAME: <br />OWNER MAILING ADDRESS <br />OWNER PHONE: <br />CONTRACTOR NAME: <br />STREET <br />CITY <br />CONTACT INFORMATION <br />TENANT NAME (If Commercial): <br />STATE <br />OWNER EMAIL: <br />cc=1 tr �`C�-, lr e9-v4- t� � vv� 1� <br />ZIP <br />CONTRACTOR ADDRESS: srReer �1� �� ����j"� G<- L'"G�I�.!�Gt � v <br />s� <br />arv -,� jZ 1 srnTe �t� ziP <br />CONTRACTOR PHONE: 2 — � `- V 2 3 CONTRACTOR EMAIL: � i/y!/j � <br />CONTRACTOR LICENSE #(REQUIRED): l � Q�� I� CITY OF EVERETT BUSINESS LICENSE #(RE UIRE <br />PRIMARY CONTACT: ❑ OWNER ��TRACTOR ❑ OTHER (Please Specify) <br />CON�ACT NAME: CONTACT PHONE: 2S —�g`� TD � Z� <br />�� �V �-� S �" ��"� �V�-�� CONTACT EMAIL: �� v i�L� ( j/1 �� C <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 />,2��,v�.a-�e_ Q � � -� �- ��'� � �-s � S-h'.-� �� �^-1� � <br />` � E� � e t� � S S '�``���-`� a� -z�--�- <br />� Y�- ��— � v v,�� �,� �"-� � <br />ASSOCIATED BU�LDING PERMIT # (if applicable): �� "-- <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fiztures 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 />ExhaustFan <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />� <br />PCUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures <br />Fixtures Fixfures <br />Toilet Backflow Preventer (Inside Bld <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 /ocal 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 />andJ.GampLy with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />t <br />uthorized Agent Signature <br />���"��5 :-, <br />Date <br />City of Everett Official Use Only <br />PERMIT # . <br />��ivtS�Z-d�� <br />(Revised 10/12/2015) <br />