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PERMIT APPLICATIO <br />BUILDIN�ECHANICAL / PLUMBING / SIGN / RINKLER / 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 />CONTACT INFORMATION <br />OWNER NAME: 1-�a,� �� TENANT NAME (If Commercial): ,�G,sr Tie� /�c. <br />OWNER MAILING ADDRESS: srReeT 1 �v <br />cilv I eYGe� - sTarE �J A ziP O�{ D <br />OWNER PHONE: ' � 3- pb - � 6 OWNER EMAIL• /y� i Ch etl � W An bC ti It Geh'i't'Y <br />CONTRACTOR NAME: J`' �/ (",� r�Q S�' <br />CONTRACTOR ADDRESS: sTReer <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �� � �� C <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER (Please Specify) ,; I�cr�o vL'��' <br />CONTACT NAME: 5�{,�.'ll'��" ��' �'i���7'> CONTACT PHONE: ��°.� _�S� ��'�j� <br />:i����r ��rrv�r'�' iS'SI��%/!C�• <br />�a�e RGs� �/�.�J CONTACT EMAIL: FO%2RL-S%JDr��SCa�G*�� IC�4,S;T, NE� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Buiiding: AG n� 7• � Mr�n�/�,c.. +A Contract Price of Work: $ �/00 OD� <br />Proposed Use of Building:�{uTo ���' �%� � ,�� ,r� eat Source: L�as ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ommercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel ❑Repair I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: �iG/�%��% l�MP�oJaMvnlT oF ,Q�/ E)us�si.tl�, 3�v��.LiK� �a� T/�IE' U,fL� oF �N <br />A�/+On�ro��Vc BioCL� �6L,� •�'�d `-�•iR✓�c.E fAG�GfTY i�/O.q.C. r/�ct �.�lcc<tA6 AN EwlGta7S�C /Kc.t24N�^�ej <br />rG i✓ 4 wl '1� �L-Pe R,c �-ia�l'S/ i✓.a�� S Q f'�� L� S �O .V�L /�'1 �SG CrG.L.O nIL d Uos Jd d Tav✓� o � r✓� <br />� J �d1L1 � A/� �RI i'. <br />/h°� �X�S3 ��� �nL'1 .�/C+J ca�J.sf.et/�r�on% �s � s�i�f 1/''B (iwad� S�dA,, <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 Fixiures # of Li of Fixtures #�f List of Fixtures # of � of Fixtures <br />Fixtures Fixtures Fixtures Fixfures <br />/ A/C - Air Handling Units Heat Pump � Toilet B B ow Preventer (Inside Bldg) <br />Forced Air Systems Unit Heater Bathtub / rinal <br />Gas Piping � Boiler y Lavatory (Wash Basin) Drinking Fountain <br />! Water Heater Refrigeration Shower Floor Drain <br />Gas Firepla � Wood Stove A Kitchen Sink 8 Disp Grease Trap <br />Gas Ra Ducting / Dishwasher � Roof Drains <br />/ Clot s Dryer Hookups Other: / Clothes W er Medical Gas <br />nge Hood / Water eater Other: <br />� Exhaust Fan / Si (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, state, 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 crrcumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which applrcation is made, <br />and / complv with the State (�ntractors Law 18.27 RCW and 296.200A WAC. <br />�'..� ` ��o <br />uthorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />1(� L� � - U�i� `� <br />(Revised 10/12/2015) <br />�'� <br />