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<br />P�i�[Vill' APPLIG�iIOfe!
<br />�111LDIRl� �CHANICAL / �LIJi�lI�Ii�G / SIC�fV / �0�l9�CLER / D�iV10LlilOf�
<br />CITY OF EVERETr PERMIT SERVICES
<br />3200 CEDAR STREET, EVERETT, WA 98201
<br />(P) 425-257-8810 � FF�X 425-257-8857 �(E) everetteps@everettwa.gov � w�,vw.everettwa.gov/permits
<br />(Blue or Black Ink Only Pl�ase) PROJECT SIYE LB�FORMAT9ON
<br />PROJECT SITE ADDRESS � �' � � � � � . "�'•;�" PROPERTY TAX # ''t E "% ���'; �,'�'' > � �'C. `~ `�'
<br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br />COW"fACI' iN�'09S6V9/�Ti06d
<br />OWNER NAME: � �;" �;;�`, TENANT NAME Qf Commercial): y� ", {
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<br />OWNER MAILING ADDRESS: sTReET "' ��� , i' j- �'-
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<br />CIIY -- i . STATF_ �,i�♦
<br />OWNER PHONE: OWNER EMAIL:
<br />CONTRACTOR NAME .. -, _ , ` . ; � . ;
<br />CONTRACTOR ADDRESS: sTREET � � �� � �,� � � �`�:� �1 ����_
<br />CITY i�-_'�,.t� . . •. STATE � .r ZIP �--f'^-�-;.
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<br />CONTRACTOR PHONE: � � ;�. CONTRACTOR EMAIL: �, -• - .
<br />CONTRACTOR LICENSE #(REQUIRED):.. -_ ,;-� ;- i-- �` ",,, '' CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):'' � f',,'
<br />PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ❑ OTHER (Please Specify)
<br />CONTACT NAME: CONTACT PHONE. r�•�, c,� �`,�-�y ;.
<br />j � �. CONTACT EMAIL � ,:,� . �l . � ` � ;�� ,
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<br />BUILDING PERMIT APPLICATION
<br />Existing Use of Building: , Contract Price of Work: $�>�'� `r��� >~
<br />Proposed Use of Building:` �=- � Heat Source: ❑Gas L`7Electric ❑Other
<br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: QCommercial ❑Industrial
<br />Type of Project: ❑New ❑Addition ❑Remodei dRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br />DESCRIPTION OF WORK ) -
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<br />ASSOCIATED BUILDING PERMIT # (if applicable):
<br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIY APPLICATION
<br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /># of # of # of # of
<br />Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures
<br />A/C —Air Handling Units Heat Pwmp 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 />SPF21N6CLEIt / SUPPFtESS10Rf SYSTEN6
<br />Number of Heads
<br />ACKNOWLEDGEMENT. I have revie�ved this application and confinn fhe information contained herein is irue and correct. Vt/ork done pursuant to this permit must comply �vith
<br />current federal, state, and local law. rhe granting of a permit only authorizes approved worl< and no deviations theretrorn. Deviations must first be authorized in writing from the
<br />Building Official before Ueing auti�or'ized unde� any cirr,umstance. I am the owner, or I am authorized by tlie owner of this property to per(o�m the wor!< for which application is made,
<br />and I comply with the State Cartractors Law 98.27 RCW and 296.200A WAC.
<br />City of Everett Official Use Only
<br />/ PERMIT# / � J �� �
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<br />Owner/Authorized Agent Siynature Date (Revised 5/20/201G) •\�
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