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� <br />� <br />� <br />ECT SITE ADDRESS: <br />PERMIT APPLICATIO ' <br />BUILDIN�MECHANICAL / PLUMBING / SIG PRINKLER / 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 />PROJECT SITE INFORMATION <br />,. ,./ ��, „ ,� _ . . , _ PROPERTY TAX #: <br />GAL for new construction: Short PlaUsubdivisio <br />ER NAME: / �p G `� <br />ER MAILING ADDRESS <br />ER PHONE:�[� ` <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS <br />CONTRACTOR PHONE: <br />CONTRACTOR LICENSE #(REQUIR <br />PRIMARY CONTACT: e�WNER <br />CONTACT Nl�ME: � <br />ff <br />�� <br />STREET �G � <br />CITY � (��� <br />9-a3i� <br />STREET <br />CITY <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />�Gi� TENANT NAME Qf Commercial) �� a�_ <br />1�iZa,.4� �.�/'�t' <br />❑ CONTRACTOR <br />, STATE uJ ✓.�"�� <br />OWNER EMAIL: ����i� l/. �l�p/1/� �2 <br />STATE <br />CONTRACTOR EMAIL: <br />CITY OF EVERETT BUSINESS LICENSE <br />❑ OTHER (Please Specify) <br />CONTACT PHONE: �� ���� � : <br />CONTACT EMAIL: �r�7� , � /(� <br />Z�P 9�Zc7 .,( <br />/�a� • � � <br />ZIP <br />2EQUIRED): <br />�� <br />��i��-��y <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: ��� Contract Price of Work: $" <br />Proposed Use of Building: d���� Heat Source: as ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: �Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition �emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: � , � <br />� , �" "' .�-�y�r-i�-"� v'v� i" 3 /b~� <br />� s /�/� D 0�. e iC; � h�.v s �:,��_ <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration _Repair <br />#°f List of Fixtures # of List of Fixtures <br />Fixfures Fiztures <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 />D 1� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixtures Fixtures Lisf 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 />ACKNOWLEDGEMENT. I have reviewed this applicafion and confirm the information contained herein is true and correct. Work done pursuant to this permit musf 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 6e authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and I comply with the State Contr tors Law 18.27 RCW and 296.200A WAC. <br />� City of Everett Official Use Only <br />/ � ^ (�� PERMIT � <br />� �� I 2- � <br />wner/Author' ed Age t Sig ure Date (Revised 1/12/2015) <br />� �-�\ <br />