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� <br />� <br />� <br />e or Black Ink On <br />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 � �wvw.everettwa.gov/permits <br />Pleasel PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: .,� � �;, %�' <br />LEGAL for new construction: Short PlaUsubdivision <br />PROPERTY TAX #: <br />No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: --� .� �>> TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREEr ��-j y �' �r'-` cy,- ,J-L, <br />CITY �Vtt ��� STATE � ZIP � � "7�) <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME; _i ,; " � ��n. � l <br />CONTRACTOR ADDRESS: sTrzeEr � , : <br />CITY - STATE ZIP � � �Z <br />CONTRACTOR PHONE: c� Z-� - s �_ CONTRACTOR EMAIL: v � y—� �' �. � C,p <br />CONTRACTOR LICENSE #(REQUIRED): -!�,�� �� °( � 5'j',✓� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED);,Qj (pL' <br />PRIMARY CONTACT: ❑ OWNER �'CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ��Z,S' _ S�J r r��,� v <br />��p �'<<�Ci � CONTACT EMAIL: ,l �,� ��, E, ��, <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: �G� Contract Price of Work: $ -1 ' ' <br />Proposed Use of Building: r_ Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />� �Ttt_�� '�'�L") Z-Z�ia%�j � I a �5.`r'_rQ '�--.�t. t.;: J �-�- S �"tic.J �izfi�c��l i l.. �s,tiy � f=► �i �zCX—K—/ <br />/ <br />�•.i�t�t+ 1� , �J �' r S- �r� � 9 � i�; � _ .S �Jy! G.. � � •,.✓L► ,f�� %-,�c,'Z 1-� (—T <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fi�ctures Fixtures Lisf 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 Fixtures # of List of Fixtures <br />Fi�ctures Fixtures <br />Toilet <br />Bathtub <br />Lavatory (Wash <br />Shower <br />nk <br />Clothes Washer <br />Water Heater <br />Sink (Service/B� <br />Backflow Preventer (Inside BI <br />Urinal <br />Drinking Fountain <br />Floor Drain <br />Grease Trap <br />Roof Drains <br />Medical Gas <br />Other: <br />Other: <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 permil only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing frorn the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the wo�k for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />�v � <br />ignature Date <br />City of Everett Official Use Only <br />PERMIT # r <br />� � � � <br />r �l � � ��� � � <br />(Revised 5/20/2016) � <br />223 .-U � ` <br />