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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 />Slue or Black Ink Only Please) PROJECT SITE INFt�RMATION <br />ROJECT SITE ADDRESS: yQa 7 �l �h S� �j�G�'�s I'�" PROPERTY TAX #: <br />EGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />�wNER NAME: G i�v D l �w�� '�-� TENANT NAME Qf Commercial): <br />ER MAILING ADDRESS: <br />OWNER PHONE: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS <br />STREET <br />CIN <br />STREET <br />f `- <br />OWNER EMAIL: <br />STATE <br />ZIP <br />CITY STATE Y v ZIP �� <br />CONTRACTOR PHONE: S ' -'3 db CONTRACTOR EMAIL: '(S �i r ,L <br />CONTRACTOR LICENSE #(REQUIRED): ,S (,( c �! CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: a 3- q - 3 OO _ <br />M. I!s I�o lw /,, r� CONTACT EMAIL: M� ��� C✓ SuODres<.�v� . e��✓� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: ; Contract Price of Work: $ O �m�- = :�- � <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 �.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: / <br />�n S�e./1 .w�o� Pro�:o�� G/can �rn� ���'e ��Pr+rssion �"�,5�..,..s �c� <br />Dra�CC� -E-he Lomrr,�r��,�1!lVt.f /{00�1'1 ��03 �OCATCOf OtT ��it eiT� f%� �VCrG/`� <br />/ / <br />ACCl1CIATFf1 RI III fIINC; PFRMIT #/if annlinahlal' �i. L.�.�. !w /�. %rr Y'7��.,� �...�. �_ <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New Addn _Alteration _Repair <br />Fixtures ��st of Fixtures Fixtures List of Fixtures <br />A/C - Air Handling Units Heat Pump <br />Forced Air Systems Unit Heater <br />Gas Piping Boiler <br />Water Fieater Refrigeration <br />Gas Fireplace Wood Stove <br />Gas Range Ducting <br />Clothes Dryer Hookups Other: <br />Range Hood <br />Exhaust Fan <br />SPRINKLER I SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATIOIN <br />Type of Project: _New _Addn _Alteration __Repair <br /># of Lisf of Fixtures # of List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside BI <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: 1 have reviewed this application and confirm the information contained he�ein 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. Devia[ions mus[ first be authorized in writing from the <br />Building Official before being authorized unde�r a �rccrnvstance. 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 1 comply with the State Contractors av�18.27 RCW 296.200A WAC. <br />City of Everett Official Use Only <br />��` � PERMIT#, <br />� .� � �� i�l�:�C �`'"�� i <br />wner/Authorized Agent Signature Date (Revised 5/20/2016) <br />� <br />• �7 <br />