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PERMIT APPLICATION <br />BUILDING �CHANICAL / PLUMBING / SIGN /�INKLER / 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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: (� Z1 (.t'. h'll�lL-� �--�� E'�L-�D <br />LEGAL for new construction: Short PlaVsubdivision <br />Lot No. <br />IPROPERTY TAX #: <br />(attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �-U Q�Ai.LT�/ �1��1 �i TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT � I�- l�v�l �� �'i— e�� <br />CITY L�� N'^-'���� ��-�� � STATE �A . ZIP ✓� L.l-J� <br />OWNER PHONE: � Z-L� ���Z • Z��� OWNER EMAIL: �'� ��A�"� L�'�Q��`��� �'�--c2- C�►`'� <br />CONTRACTOR NAME: L�-��� Q�� �NC� CL-'• ��G- <br />CONTRACTOR ADDRESS: sTReer P.O. �X —?'3 � 2� J <br />CITY Pli 7f^���P STATE ��"'" ZIP �����' <br />CONTRACTOR PHONE: Z�`3 ��E�'' �� t 9-7 CONTRACTOR EMAIL: -��N ��`' �-����-� C�. COM <br />CONTRACTOR LICENSE #(REQUIRED): L-EC��NR-�--y�4t71�1 CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ��Z�JO <br />PRIMARY CONTACT: ❑ OWNER L�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ��j(� .-r-� �G -� Z� I <br />F�C�--�/ 1.1.1F�1�-� �� <br />CONTACT EMAIL: �C'�Y � LF�����=�c�-C=GM <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached ❑SFR-Attache <br />Type of Project: ❑New ❑Addition ❑Remodel <br />nFSCRIPTION OF WORK• <br />BUILDING PERMIT APPLICATION <br />Contract Price of Work: $ �-7���•1.-�� <br />Heat Source: ❑Gas ❑Electric ❑Other_ <br />d ❑Duplex ❑Multi-Family-# of Units: ❑Commercial <br />❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan <br />+ T�C <br />❑Industrial <br />e of Use <br />��(Z DFF C�DMP / 1 tJaTAC�. `1� 1��� �c�3 � I�Iro��-L� <br />�� •���_ .___ GG t,-i �x�� i i 1 C�n.l <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtu es List of Fixtures Fixtures List of Fixtures <br />A/C - Air Handling Units <br />Forced Air Systems <br />Gas Piping <br />Water Heater <br />Gas Fireplace <br />Gas Range <br />Clothes Dryer Hookups <br />Range Hood <br />Exhaust Fan <br />Heat Pump <br />Unit Heater <br />Boiler <br />Refrigeration <br />Wood Stove <br />Ducting <br />Other: <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 Fioor 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 />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: 1 have revrewed this application and confirm the information contained herein is true and correcl. 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 />Burlding 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent <br />`_I Ir�• �(o <br />Date <br />City of Everett Official Use Only <br />PERMIT # <br />_ � �� <br />(Revised 5/20/2016) <br />