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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 />CONTACT INFORMATION <br />OWNER NAME: � TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srFteer Z�;�.j `; �� �;�: t"ll h�:^ <br />PHONE: <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS <br />CITY <br />STREET <br />CITY <br />CONTRACTOR PHONE: ��( "` � <br />� �' <br />CONTRACTOR LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER � <br />CONTACT NAME: <br />�, �� £��� r�-c: <br />Use of Buildin� <br />d Use of Buildi <br />Tvae: �,SFR <br />Type of Project: LJNew I <br />DESCRIPTION OF WORK: <br />- STATE <br />� �� OWNER EMAIL: <br />r � <br />L' �� � i' ■ ry i 'y^i- <br />1/v <br />, i i� •1. 1! 1• STATE <br />L' CONTRACTOR EMAIL: ( � � � <br />�3 ��' CITY OF EVERETT BUSINESS LI <br />R ❑ OTHER (Please Specify) <br />CONTACTPHONE: ,�� �..�(/ <br />� <br />r, a� r CONTACT EMAIL: t�/', nn � .�� U <br />ZIP � <br />ziP �l <br />!� ft l�� <br />E #(REQUIRED): <br />7' (i: <br />BUILDING PERMIT APPLICATION <br />_ �� � <br />Contract Price of Work: $ <br />Heat Source: ❑Gas lectric ❑Other <br />❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />on ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />s��_ � ���� � <br />BUILDING PERMIT # <br />c�,�� ��c� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixtures Fintu es List of Fiztures <br />A/C — Air Handling Units Heat Pump <br />Forced Air S stems 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 />� �� ���- �� <br />PLUMBlNG PERMIT APPLICATION <br />Type of Project: New _Addn _Alteration _Repair <br />Fi tures List of Fixtures Fixtu es List of Fixtures <br />Toilet Backflow Preventer Inside Bid ) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink 8� 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: 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 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 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. � �� <br />City of Everett O�cial Use Only <br />PERMI� # �� <br />� <br />(Revised 10/12/2015) `� 2 <br />