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� <br />� <br />� <br />PF_RMIT APPLICATION <br />BUILDIN(�ECHANICAL / PLUMBING / SIGN /�INKLER I DEMOLITIOiV <br />CITY OF EVERETT PFRMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � v✓vwd.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: %G!`./I (.J C�.i./.� IZ �� PROPERTY TAX #: <br />LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legaf description) <br />OWNER NAME: �jJ?L� j�-jLJtS�fy� <br />OWNER MAILING ADDRESS: srREET % UG <br />cin �V� � <br />OWNER PHONE: �L-�' 3!� �' ���('� <br />CONTAGT INFORMATION <br />TENANT NAME (If Commerci <br />;✓ C-.�¢S'Ln�� Ci 12.1i -r �1�.t� <br />�OWNER EMAIL: <br />STATE <br />Z�P 9 ��.� <br />�,CONTRACTOR NAME: S�_v\ � 0 f� `_�r Y" 1,' , C E' � O �C- -1 �11. � C�r"�.l ( � � "l CC?L�� � �L <br />CONTRACTOR ADDRESS: s�Reer � I(� L� � �� ���`r fi I� C��^ �� S �� �� - � <br />CITY � � � � � STATE ti' � ZIP <br />CONTRACTOR PHONE: �-} Z-`� - 7� S - z Z Z z-- CONTRACTOR EMAIL: �'�') I'1 ti'` C 2' `._� � j C a D t� <br />CONTRACTOR LICENSE #(REQUIRED): � �"-�� „�, �,;+ � �� � �f �? ,; i" CITY OF EVERETT BUSINESS LICENSE #(REQUIRE <br />__.__ . ._.. _ _ __ _-- _ __ . __ .,.__.. _ __..__ __ _... __ ...__ _.._.. _ ._. ,_, . _. <br />PRIMARY CONTACT: ❑ OWNER L�l CONTRACTOR ❑ OTHER (Please Specify) _ <br />CONTACT NAME: CONTACT PHONE: <br />�C� L� J L�S� � CONTACT EMAIL: <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached <br />❑ S FR-Attache <br />Type of Project: ❑New ❑Addition ❑Remodel <br />DESCRIPTION OF WORK: <br />,r� ��D�,�-�F_ �l�-� <br />�25- 3f Z- �{-�f-T � <br />,--v� ���, r � � 5 � S L � C� '� <br />BUILDING PERMIT APPLICATION <br />Contract Price of Work: <br />Heat Source: ❑Gas <br />d ❑Duplex ❑Multi-Family-# of Units: <br />❑Repair ❑T.I. ❑Siqn ❑Sprinkler <br />i.J �i�� �G�i'� <br />ASSOCIATED BUILDING PERMIT # (if appli <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures Lisf of Fixfures Fi�ttures List of Fixtures <br />A/C -Air Handlina Units Heat Pump <br />Gas Piping <br />Water Heater <br />Gas Fireolace - <br />Clothes Dryer Hooku <br />Range Hood <br />Exhaust Fan <br />Unit Heater <br />Boiler <br />Refrigeration <br />Wood Stove <br />Ducting <br />Other: <br />❑Electric ❑Other <br />❑Commercial ❑Industrial <br />❑Demolition ❑Chanae of Use <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtuies #°f List of Fixtures <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 />Dishtivasher Roof Drains <br />Ciothes Washer Medical Gas <br />Water Heater Other: <br />Sink (Service/Bar/Mop/etc.) Other: <br />SPRINKLER / SUPPRESSION SYSTEM � <br />Number of Heads <br />1CKNOWLEDGEMENT: I have reviewed fhis application and confinn fne rnformation conta;ned herein is true and correct. Work done pursuant to this permit must comply witfi <br />urrent federal, state, and loca! law. The gran!ing of a permit only authorrzes approved �ro�ork and no deviations theref�om. Deviations must first be authorized in writing from the <br />3uilding Official before being authorized under any circumstance. I am the o�mer, or f am authorized by the owner of this property to pe�form the �vork for which application is made, <br />n7�t'1�c�ly with the State Contractors Law 18.27 R�y}Laad-296.200A �VAC. <br />/'U - �N -aorG� <br />ent Signature Date <br />City of Everett OKicial Use Only <br />P#Lc� c 0�- a� 2� <br />(Revised 5/20/2016) <br />