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PERMIT APPLICATION <br />BUILDINt�ttMECHANICAL / PLUMBING / SIGN / S'rk�NKLER / 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 />(Blue or Black Ink Only'Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: �y [� �i:C Y'rv� f� i C,cj Y�� �(�y PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: j e, ��� � TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: s�eEr `;3 � G� � C<� 5. ti <br />CITY �� C{, � STA7E W/"� ZIP �� � V y <br />OWNER PHONE: L{ �Z. y- 3�{ Z- Z 1'Z � OWNER EMAIL: <br />CONTRACTOR NAME; 4.7 , t.t i,v� u✓� t� ��, C u ��- 5� r`'� �� v+�' S in <br />CONTRACTOR ADDRESS: snzE� � �( ' � � ; .-� � :, ,.- -� L7 :— _ <br />CIlY �} � � I a 'b� � t""� (sf VV�- STATE � � ZIP � � � Z �y <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): � �/� �(� �3 V�J {,., E, �?. CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �L '-f Q� j� <br />PRIMARY CONTACT: ❑ OWNER Ql CONTRACTOR ❑ OTHER (Please Specify) <br />C�NTACT NAME: CONTACT PHONE: 3 4�? _ �-L `.- t j y �; � <br />_.-� ,, i` <br />..� i. ��- l-1 �x w1 iJ t�• }- CONTACT EMAIL: '�'I. a.t. r( b C d^ }' 1-y ' = i. ::> .'�-� <br />BUILDIN <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupl <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair <br />DESCRIPTION OF WORK: <br />.� Fti��'�:�:�� ,�, <br />I-L�������� � � <br />ASSOCIAT t7�t1VQ- MIT #(if a licable): <br />MECHANICAL P� MIT APPLICATION <br />Type � ' t:==New _ Addn _Alteretion _Repair <br />Fixtures Lisi of Fixtures Fixtu es List of Finfures <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 D er Hookups Other: <br />Range Hood <br />Exhaust Fan <br />PERMIT APPlICATION <br />Contract Price of Work: $ <br />Heat Source: ❑Gas ❑Electric ❑Other <br />❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />❑T.I. ❑Sian ❑Sorinkler ❑Demolition ❑ChanQe of Use <br />�;� t t�a �.- � �� I c� c� � 5' S lo <br />PLUMBING PERMIT APPLICATION <br />Type of Project: New _Addn Alteretion Repair <br /># of List of Fiz�ures # of Lisi of Fixiures <br />Fi�Rures 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 />SPRINKLER / SUPPRESSION SYSTEM � <br />Number of Heads <br />ACKNOWLEDGEMENT: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuanf 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 authonzed in wnfing f�om the <br />Building Offcial before being authonzed under any circumstance. 1 am the owner, or I am authorized by the owner of this properfy to perform the work for which application rs made, <br />and 1 comply with the State Cont�actors Law 18.27 R�W and 296.200A WAC. <br />/ City of Everett Official Use Only <br />:� PE M # ( (' 2 <br />%'/� � r� �>> ✓�'� i� la � b l� J <br />, <br />OwnerlAu�horiz� Signature Dat (Revised 5/20/2016) <br />-- - - '" <br />- — � C � � <br />... _._ _ . � / <br />_ .___ _._----- <br />� <br />J. � � <br />