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PERMIT APPLICATION � ' 2-2 ` <br />BUILDINC�ECHANICAL / PLUMBING / SIGN �RINKLER / DEMOL ltC1�� 2 <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: 2�� � a��Q�� �,v� PROPERTY TAX #���� �,.��r,.)�� ��,� <br />�L.ECzAL for new construction: Short Plat/subdivision_ <br />OWNER NAME: J <br />OWNER MAILING ADDRESS: sTReer O <br />aTv <br />OWNER PHONE: �' Z'�',� •4 3� . q C <br />CONTRACTOR NAME: � <br />���NTRACTOR ADDRESS: sTReer C <br />Lot No. (attach copy of long legal description) <br />IN�ORMATION <br />TENANT NAME (If Commercial): <br />� .. _ n �_ J <br />STATE � <br />OWNER EMAIL: <br />• �. <br />ZIP <br />i <br />CITY ���� STATE �� ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: (, � �� , G <br />CONTRACTOR LICENSE #(REQUIRED): � � � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): O52QC�-O <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />,�;,:�.� `��.a CONTACT EMAIL: ' L:�� • CU M <br />�,�, ( � � �s'" <br />BUILDING PERMIT APPLICATION <br />�xisting Use of Building: Contract Price of Work: $ �J � � O <br />Proposed Use of Building: � Heat Source: ❑Gas ❑Electric ❑Other l/�� �V <br />Quiiding Type: ❑SFR-Detached �R-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel �pair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />(/�(� � � ��� � rl �.%� - <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn Iteration _Repair <br />Fixtures List of Fixtures Fixtu es 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 _Repa�r <br /># of List of Fixtures #°f 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 />�1CKNUWLEDGEMENT: 1 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 on/y 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 1 am authorized by the owner of this property to perform the work for which application is madg, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. � Q�S, � <br />City of Everett Official Use Only � �' v <br />PERMIT" <br />� �� O I <br />OwnerlAuthorized Agent Signatur Date (Revised 10/12/2015) <br />