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� • <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 � wvwd.everettwa.govlpermits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT S1TE ADDRESS: ��� �"u� � C� :�� ��' ��G�h� PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />ER NAME: <br />ER MAILING ADDRESS: sTREET � � <br />arr � �/`l°.� <br />CONTACT INFORMATION �`SGp� <br />TENANT NAME (If Commercial): G'( <br />� � <br />��. i` 4�� �4N �` n� � v�� cf <br />STATE <br />LIP <br />L <br />OWNER PHONE: yZS ,.��2- ��G ��-% IOWNER EMAIL: _ <br />CONTRACTOR NAME; � j, j�L �; �-� ('� ��-�,� �(�U'V�.� Yj i`�g �� L. ` <br />CONTRACTOR ADDRESS: sTReeT i 8b "�, � I� 7iJl � A�� _NG <br />CITY ��( I � STATE w� ZIP ��'' v <br />CONTRACTOR PHONE: � ��, , (� . Z CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): �,� �,0,{� 9(� � CITY OF EVERETT BUSWESS LICENSE #(REQUIRED): O`j ' <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ' ZS � , G� �- ��' <br />hC� � �- � CONTACT EMAIL: <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ <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 ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />�5'I-�t (. � � � Cc.h A W Q-S � � r tn. <<. <br />OCIATED BUILDING PERMIT # <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixfures Fi�ctures List of Fixfures <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 />SPRINfCL.ER / SUPPRESSIAN SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures �°f List of Fixtures <br />Fixtures Fiactures <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 pursuant to this permit 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 authorized in writing from the <br />Building Official before being authorized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and I comply witli the State Contractors Law 18.27 RCW and 296.200Fl WAC. <br />City of Evereft Official Use On/y <br />� '� PERMIT # <br />� }�l �`( I�, t�l(o�i � D(� <br />Owner/Autho iz . Age t S n ture Date (Revised 5/20/2016) <br />