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PERMIT APPLICATION <br />BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / 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 />ROJECT SITE ADDRESS: !?f �� C�� �J ��t'4� PROPERTY TAX #: <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ��/�� C✓blp,�/70/� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREEr ��� �Q �`1S�G Co l� �� <br />CITY �� ('✓�.-� STATE V�/� ZIP �(j W I <br />OWNER PHONE: �J ZS ' 3�� 3 f(� � OWNER EMAIL: I V�� .' �1/l 5i�.�'� CG� ✓Yi , r. L,,nn <br />CONTRACTOR NAME; ��� i2� ��(„/ " SL l v h(�'� <br />CONTRACTOR ADDRESS: srReer /U -J 'J �% � ` C �^/ <br />CITY y• I�JG`( (�! C(� STATE ��1 ZIP �� Z/S <br />CONTRACTORPHONE: ZS- �"���" �~3�� CONTRACTOREMAIL: �j//t O✓� r .(.ti�n <br />CONTRACTOR LICENSE #(REQUIRED): I�� I'e,e� �'JU� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): � Z�� <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: � CONTACT PHONE: � ZS - 0 � — �j � �� <br />(�YG+I'��� �� ��p <''�' � CONTACT EMAIL: b�G n ' D✓! � ,�,� �� L��1 <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: � Contract Price of Work: $ ��f�Y�" �'� �,'�;} ll'�(�"� a���, <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 />�� ' ' ','� � a <br />���� i�� '� �� � �; ,,��� , ,�,'"��� i� UT,:�' ����a. ?_. <br />i <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn �Alteration _Repair <br />Fixtu es List of Fixtures Fixtu es Lisi of Fixtures <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 # of List of Fixtures <br />Fixtures 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 />ACKNOWLEDGEMENT: I 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 tlieref�om. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />gent Signature <br />City of Everett Official Use Only <br />��� P E RM I T II � r,� ,� '� f,� <br />G l 4 'i �� ',, ,,� � ; � �� `��, _- , ����,, � <br />Date (Revised 5/20/2016) <br />