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PERMIT APPLICATIO� <br />BUILDIN�ECHANICAL / 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 />PROJECT SITE ADDRESS: �. '� (/11 ��/� Z(, ROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ��'j"- � I�ANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT <br />C ITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME; � 2 c <br />CONTRACTOR ADDRESS: srr�eeT lI �/� , L122� <br />CITY - 7' STATE ZIP Z� <br />CONTRACTOR PHONE: Z�� � - D 23 CONTRACTOR EMAIL: �- L <br />CONTRACTOR LICENSE #(REQUIRED): (/ �� �j� CITY OF EVERETT BUSINESS LICENS EQUIRED): `_ S <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />CONT T NAME: CONTACT PHONE: — P—(J ly� <br />� <br />'�-2 � I�� �,v� CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: 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: ew ddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />��' ���-�-,, � �1,� ��� '�.,�h-�l,�-�. � � �`��- l �-1 i-�-c,�.�-.� . <br />� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures # of List of Fixtures #�f List of Fixtures # of List of Fixfures <br />Fixtures Fixtures Fix ures Fixtures <br />A/C - Air Handling Units Heat Pump 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 />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <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, siate, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. 1 am ihe owner, or I am authorized by the owner of this properly to perform the work for which application is made, <br />and 1 comt�wrt�the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent Signature <br />City of Everett Official Use Only <br />j`� PERMIT # <br />� � �2� 1 L� � � 0�1- �2 <br />Date (Revised 5/20/2016) <br />