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PERMIT APPLICATIOI <br />BUILDIN(� i iJIECHANICAL / PLUMBING / SIGN / SPRINKLER / 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 />PROJECT SITE INFORMATION <br />PROJECT S1TE � j�, RESS: L 1 ��� (� :t t��-` `�; _ ,�_� PROPERTY TAX #: <br />[� � <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: I�i C� _,-�-� _ �� :� l; � �' TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREer ,�, �C� — �V,{ �%t t. � �� <br />CITY -- y`.�� l_.� 2.�1�- STATE � i_ !'.� .. ZIP �� (�.• � l.' 1 <br />OWNER PHONE: � L_ `� z`j��j �_� l''� 1 OWNER EMAIL: lf_��.� �lf %-r' �`� I�r Y�- r'C�a�'( -:��� �1 �-c ��' y__ <br />CONTRACTOR NAME; %ti � � -� � �; ���: { �� � � V � � � %J l � �L-' <br />CONTRACTOR ADDRESS: sTREEr ?� I c� ' 1�1 � �� I�---� , j`� <br />CITY � ( •.(;_ [- ' �"��Y ��7 ���L�� � STATE 1 ,:��'� ZIP � � �� � � _ j <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: �} �' ` j ;�-f -c_Lr S����.., v���i . t lL� C IICt<< <br />CONTRACTOR LICENSE #(REQUIRED): �Y"+ L Z P_��� `�,�:�'-'�, � V, F� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �] /� �� <br />PRIMARY CONTACT: ❑ OWNER I�CONTRACTOR ❑ OTHER (Piease Specify) <br />CONTACT NAME: CONTACT PHONE: z�� �r :�y � ��� S� <br />'� C-t ,�vC_�v�� ` `i�f_c.�� C� <br />�. � � � CONTACT EMAIL: �'��'� s CC �A �� � �';� LL'tr� V�� rx=� �� � I�i kw�C� .(C' , <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: �-�i?�.. i' �`�`) Contract Price of Work: $ ��? ��' �, �' <br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />� _�� �,� ,��� ���� � � � � <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fi �ures List of Fixtures Fixfures List of Fixfures <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 />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures #�f List of Fixtures <br />Fixfures Fixtures <br />'�. Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Fountain <br />f Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />Y Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: l have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comp/y with <br />cu�rent fede�al, state, and local law. The grantrng of a permit only authorizes approved work and no deviations therefrom. Deviations must firsf be authorized in writing from the <br />Building Official before being authorized unde� any ci�cumsfance. I am the owner, or l am autho�ized by the owner of this property to perform the work for which application is rnade, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Owner/Authorized Apent�$iqh�t�re <br />City of Everett O(ficial Use Only <br />PERMIT # <br />��% �l�C� 3 `C�� � <br />Date (Revrsed 10/12/2015) <br />