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� <br />� <br />� <br />PERM17 APPLICATIC: <br />BUILDLd� / MECHANIC�4L / PLUMBING / SIGN / SPRIIVKLER / DEMOLITIOiV <br />CITY OF CVERETT 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 />(Blue or �lack Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ZG LU S$ � S� PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br />CANTACT INFORMATION <br />OWNER NAME: Q �� �✓SJ,� TENANT NAME (ff Commercial): <br />OWNER MAILING ADDRESS: sraEEr `G L� S� j r Sw <br />CfIY �v�e- � I STATE ✓� " ' ZIP �� �"� J <br />OWNER PHONE: �ZS ' y� ` ' � v �� OWNER EMAIL: /"�G� �� /CvS�� /' C'� �+^ 6�i �' ��� <br />,_, _. _..... ..._.,,... <br />_. <br />.,-.. <br />_ .. . . . . _.. .. <br />CONTRACTORNAME; �I �� �r/W ��i/�IL��'� 5 <br />CONTRACTOR ADDRESS: srReEr l D 7 j j y% / t- W <br />C�N �l��l���� STATE l,✓'�l Z�P �'/��j�Z7s <br />CONTRACTOR PHONE: �/Z�� (Jv`�- 3-� `%I CONTRACTOR EMAIL: �'l<'G✓�e�/1 �' lpC/i��- cz-��'� <br />CONTRACTOR LICENSE #(REQUIRED): �CL/�� 5 g�j`�JDL CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �/'(pZ �g <br />PRIMARY CONTACT: ❑ OWNER ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �ZS -`�(�t�- 3,)'�� <br />I�6Gryl��✓J ��D��`J CONTACTEMAIL: �y��. -n � ��CQ, C�-✓� <br />BUILDING PERMIT APPLICATION <br />Exisfing Use of Building: f'�5, �(�'Psf Contract Price of Work: $ �-s00 - <br />�� <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: ew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION O WORK: ,/J�- <br />I��'lG� e ./(��_�v✓<<� ��,5 �i,��n��CC' <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures Lisf of Fixtures F��ures 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 #°f List of Fixtures <br />Fixtures Fi�ctures <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 Medicai Gas <br />Water Heater Other: <br />Sink (Service/BadMop/etc.) Other: <br />ACKNOWLEDGEMENT. l have reviewed this applicafion and confirm Ehe information contained herein is true and correct. Work done pursuant to this permif must comply with <br />curnent federal, state, and local law. The granting of a permit only authorizes approved worl< and no deviations therefrom. Deviations musi frrst be authorized rn wrifing from the <br />Building Official before being authorized under any circumstance. l am the owner, or I am aufhorized by the owner of this property to pertorm ihe work for which applrcation is made, <br />and I comply wifh the State Contractors Law 98.27 RCW and 296.200A WAC. <br />�� <br />orized Agent � <br />0 <br />rc <br />/p-�-Il� <br />�� <br />City of Everett Official Use Only <br />PERMIT # <br />� <br />(Revised 5/2 /2016) <br />