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PERMIT APPLICATIO <br />BUILDINCC�IIECHANICAL / 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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �� � �� �� S� PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: � e, � zz�.; (�/Y TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTRee-r �`i! ��� S� <br />CITY (/�,rZ��� STATE � �}- ZIP ( � �� � <br />OWNER PHONE;p�lJ(p —� 3S ( %� OWNER EMAIL: <br />CONTRACTOR NAME; K�/��S f'-f<z�� 3•�- ,�,ir �� j <br />CONTRACTOR ADDRESS: sTReeT �yC� L�/�- < <" �c. <br />CIN �R �1 N 7/�/' STATE l,� %4� ZIP ���� <br />CONTRACTOR PHONE: '�'� ' �— "" CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): � j.15 � � ' ��! CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ��� % � <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: —�%-�S��l� <br />��( �-Z�� CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $_5�'� <br />Proposed Use of Building: Heat Source: �as ❑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 />��� t�c i 5?' � r� V/�-5 �i�f HiC��4' V'�; ►�� <br />�e� �� 5 <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixfures Fixfu es 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 ;y � <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 Fixfures #°f List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinai <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 musf comply with <br />current federal, state, and local law. The granting of a permit on/y authorizes approved work and no deviations therefrom. Deviations musf firsf be authorized in w�iting from the <br />Building Officral before being authorized under any circumsfance, 1 am the owner, or 1 am autho�ized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everetf Officral Use Only <br />PERMIT � <br />lr �- � 7 / � (�' <br />Owne Authorized Agent S' nature Date (Revised 5/20/2016) <br />