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3 <br />E�' <br />PERMIT APPLICATION <br />BUNLDING ::::=CHANICAL / PLUMBING / SIGN �" ZINKLER / 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 />PROJECT SITE ADDRESS: ��. _�_�,��.o.�+� PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision i�'-j �V� f.'_.l�"C ����• e11 �� Lot No. 3 i �,L(attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �;,��,..� �; ��`�i �fi2,�J�e'r�(�;,-� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReer �.(y „� (,,,� � i c,� � /� <br />CITY �j/ �(,�'T STATE �;�i/0°� _ ��! ' ' � <br />ZIP o <br />OWNER PHONE: �(i(, - � ' +-f ^ C>.%„ % �j' OWNER EMAIL: � �•r� {. � ,. �� � �r,�.71C: (i,S� . � � <br />CONTRACTOR NAME; ��.�,1 n� (_ }"'� <br />CONTRACTOR ADDRESS: srReeT <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />_ <br />PRIMARY CONTACT: �' OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: <br />CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: S7G a9� (., �� Contract Price of Work: $ <br />Proposed Use of Buiiding: 1�� ;;(,,�'i !CV^� 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: <br />C C� c`�'l .: �' ✓Il,� c�'e I a' v� " x ��; � � J'" �fr���lr.� r�1 �2, �l � %'e��ei � r",,�� : �.:'�° C�� 7z ��i �- E X )—F:%,�, -� <br />�' %� f iCI� r rIJC� �-/i'..�5 G-fi'. . <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixfures List of Fixfures Fixtures List 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 />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixfures #°{ List of Fixfures <br />Fixtures Fixtures <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 />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuanf to this permif 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 aufhorized in writing from fhe <br />Building Official before being authorized under any circumstance. 1 am the owner, or l am autho�ized by the owner of this property io perfo�m the work for which application is made, <br />and l comply with the Sfate Contracfors Law 18.27 RCW and 296.200A WAC. <br />� <br />ent Signature <br />City of Everett Offrcial Use Only <br />PERMIT � <br />�V �� �� �-i'� <br />)at (Revised 90/12/2095) <br />