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PROJECT SITE ADDRESS: <br />PERMIT APPLICATION <br />BUILC►IN�IIECHANICAL / 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 />PROJECT SITE INFORMATION <br />LEGAL for new construction: Short Plat/subdivision ��£', Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: TENANT NAME (If Commerciai): , <br />OWNER MAILING ADDRESS: sTRee-r S <br />CITY STATE ZIP <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME; � �� � \ l� � ►�+ <br />CONTRACTOR ADDRESS: sTReer ' (�'j � U b� � `� <br />_ l ��� � J CITY STATE �� - • ZIP �� � �' "� � <br />CONTRACTOR PHONE: /=� �,�� -� 7�"J �- �� 3C� �' CONTRACTOR EMAIL: "-��("�i'Y1 U'�Y"��l'� ((;� z} - G„t i <br />CONTRACTOR LICENSE #(REQUIRED): CC_ i y-���il C�I�.�C.r �� I a CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): C..� ��� <br />PRIMARY CONTACT: ❑ OWNER �F3�ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: � F � CONTACT PHONE: �2Z) -` %`) C- C� 7j � C�i <br />;. ��r�1�`�! � s�r=i� � , <br />-� CONTACT EMAIL: `� r�,�'Y( i,.,' � I'� ( I�? � L�• � L� �j,�t ,C� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: (,( �� rj)l� Contract Price of Work: $ �(J <br />Proposed Use of Building: � i �/ 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: }.1,���� /JC.-1.�. iA; ��,il` ; 1 bi �"t'C�I I �V'N ��' �� / P� t v..'Ci � V -�-F£r� � y� <br />�ti1��� �'��-�' C����'�-� � G'vti�� � �1L'�/�t i�'X=.`�"(-' t����6� �, <br />ASSOCIATED BUILDING PERMIT # (if a.pplicable): <br />MECHANICAL PERMIT AIPPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures #�f Lisf of Fixtures # of Lisf of Fixfures �°f List of Fixfures <br />Fixtures Fixt,ures Fixtures Fixfures <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 / SUPPRESS!ION SYSTEM <br />Number of Head:> <br />ACKNOWLEDGEMENT: 1 have reviewed this ap,olication and confirm the information contained herein is true and correct. Work done pursuant to this permit must comp/y 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 autho�ized in writing from fhe <br />Building Official befo�e be g authorized under any circumstance. 1 am the owner, or I am authorized by the owne� of this p�operty to perform the wo�k for which application is made, <br />and I comply with the Stat Contractors Law 18.<'7 RCW and 296.200A WFlC. <br />_ % � " Z�%� W <br />Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />� `lS/ D �� � � <br />(Revised 10/12/2015) �� <br />2 <br />