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PERMIT APPLICATION <br />BUILDING �CHANICAL / PLUMBING / SIGN / �INKLER / 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: ��� c �. .�� /��� PROPERTY TAX #: <br />(. <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />OWNER NAME: �JIC�G'l.G�--'�C%� d <br />OWNER MAILING ADDRESS: sTrzeer <br />CITY <br />OWNER PHONE: �`� • �� � • � � <br />CONTRACTOR NAME: I< <br />CONTRACTOR ADDRESS <br />CONTACT INFORMATION <br />TENANT NAME (If Commercial <br />�S �.�-e G�.� � <br />�OWNER EMAIL: <br />; �, � ,. � � ,, i _ .',.- ( <br />STREET �O ��� <br />GTY � �A .k-�/I�J� �- <br />STATE �� �„ ZIP <br />ti ��S <br />STATE L V� ZIP <br />CONTRACTOR PHONE: �`'S(.E�C • (.��� SS • `���:C:C�v CONTRACTOR EMAIL: ( � LcV � � <br />CONTRACTOR LICENSE #(REQUIRED): P�-�-�� � c � :�� � CITY OF EVERETT BUSINESS LICENSE <br />PRIMARY CONTACT: ❑ OWNER �] CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: -�C , 4j�� .G�;U <br />� <br />��D M�ri fA . (� R � v� /L � CONTACT EMAIL: ; ti. ,�Li,r C? /1 �-,S�i, <br />��' � <br />-� U <br />BUILDING PERMIT APPLICATION <br />xisting Use of Building: Contract Price of Work: $ l�Z�'�% <br />roposed Use of Building: Heat Source: ASIGas ❑Electric ❑Other <br />uilding Type: �SFR-Detached I�.SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />�rpe of Project: ❑New ❑Addition ❑Remodel �epair ❑T.I. ❑Siqn ❑Sprinkler ❑Demolition ❑Chanqe of Use <br />ESCRIPTION OF WORK: <br />� <br />���-�` -� �'_�f�`A-C� (L <br />SSOCIATED 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 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 />��.�-L c�� k%� +1oi <br />�� <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures <br />Fixfures 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/Mopletc.) 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 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 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 />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />�� <br />PERMIT # <br />l �, �� �Z � I�� � �� � <br />Own /Authorized Agent Signature Date (Revised 10/12/2015J <br />