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� <br />� <br />� <br />PERMIT APPLICATIO <br />BUILDIN�ECHANICAL / PLUMBING / SIGN RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 I 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: ���,/ �'" � � �:1J �'i�c°''%',:' PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ,�(�f/"� �' �i.''*�f'CZ LL�L TENANT NAME (If Commercial): -- <br />.� I <br />OWNER MAILING ADDRESS: srReeT ��%/ 2,� t' tiJ <br />CITY �{,�c� 1° Ly t� STATE lJv �. ZIP ���j <br />OWNER PHONE: �� ��� ' ;�� - /� /�/>'' OWNER EMAIL: (,�(�. ���; �%�,�{�i C�C-- a CC� <br />CONTRACTOR NAME; �,� �,�sv ; 'r�Lui°'��i�� ��jo� � rl�iyl <br />CONTRACTOR ADDRESS: sTREer /���Ll� / �� �� �'�Z , SC <br />� <br />GTY �j 1/C' STATE rj✓� ZIP ��UG�� <br />CONTRACTOR PHONE: - Ci� y� 7- ;,�T� % CONTRACTOR EMAIL: c"'i�a�, , L�.SK i,ti� '� C��C�I'� 'c�" ✓ <br />CONTRACTOR LICENSE #(REQUIRED): �/,�!-4� +�l��s r( 7C� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �"1�5� <br />PRIMARY CONTACT: ❑ OWNER C'3' ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: { CONTACT PHONE: �� �,�'7 ��� <br />�i` ) � �J f (.;° j �-�p ) �'1� CONTACT EMAIL: � /F�_ <br />�� i/-�.ti -> �T�-� � ).'�7J ���`�7'1'�C�S�� �� <br />BUILDING PERMIT APPLICATION <br />/ ''v« � - ° `= <br />Existing Use of Building: '�� s,vyV��7� ���'�—' Contract Price of Work: $ �" / l7 <br />Proposed Use of Building: �f`Sr�(?iE'-l�t�l( � .s j� j Heat Source: C�G s ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached uplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel C�'}�epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />� �<<tt� ��J,�-; �. �iS �r rr?t1C��- � C%z-✓�r�,��� <br />�'�1�C�r`� �J�J ✓� � % <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of Lisf of Fixtures #�f List of Fixfures # of List of Fixtures #�f List of Fixfures <br />Fixfures Fixfures Fixfures Fixfures <br />A/C - Air Handling Units Heat Pump Toilet Backflow Preventer (Inside Bldg) <br />Forced Air Systems Unit Heater Bathtub Urinal <br />Gas Piping Boiler Lavatory (Wash Basin) Drinking Fountain <br />Water Heater Refrigeration Shower Floor Drain <br />Gas Fireplace Wood Stove Kitchen Sink & Disposal Grease Trap <br />Gas Range Ducting Dishwasher Roof Drains <br />Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br />Range Hood Water Heater Other: <br />Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the informafion 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 fi�st be authorized in writing from the <br />F3uilding Official before being authorized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this properfy to perfo�m the work for which application is made, <br />and l comp/y with the State Contracfors Law 98.27 RCW and 296.200A WAC. <br />�- <br />r/Authorized Agent Si <br />City of Everett Official Use Only <br />PERMIT .,, <br />7-� �6 � � r V L' <br />Date (Revised 5/20/2016) <br />