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� <br />� <br />� <br />• PERMIi 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 � www.everettwa.gov/permits <br />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ..-- �� �j /"��, f j%G; PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �S �` � o� ;�- e TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREEr Z C7 ��i> (�L � G <br />cirv � llcf �%� srnrE �/� ziP �� C� � <br />OWNER PHONE: � Z,�- ,S-'� ^ Lj � OWNER EMAIL: Gr/Gv c,�/ ,� /,. c v <br />CONTRACTOR NAME: f' / r )� -� ' n <br />CONTRACTOR ADDRESS: sTReeT � � �'/ � /�(.J�'_� ,/-=' <br />CITY � �,' � J,' (�� ' � STATE � ZIP ( � <br />CONTRACTOR PHONE: �, �' � - � ---� CONTRACTOR EMAIL.✓id� �'"`� ' r� ( . „J f ��: .�� �� <br />CONTRACTOR LICENSE #(REQUIRED): �'jii/ ' ? � �'-' % CITY OF'E'�Y/E�ETT BUSINESS LICENSE #(REQUIRED): 0 � J � <br />__ _ _ __ _._ <br />PRIMARY CONTACT: ❑ OWNER f�'CONTRACTOR ❑ OTHER (Please Specify� <br />CONTACT NAME: CONTACT PHONE: � U �z _, 5---� � 7� � <br />� �. � � �4 � CONTACT EMAIL: � S` - <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: �� Contract Price of Work: $�-S -3 S�!? �o <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:-T� <br />-�c-- h �' �`"��% /V � i�(y � %� rc �( �t'' a U� h rv c � �- a � <br />(��- �'XJ.J�///���///��� <br />-`� i <br />✓ <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixtures Fixtu es 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 Fintures #°f List of Fiarfures <br />Fixfures 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 />ACKNOWI_EDGEMENT: I have reviewed this application and confirm the informafion contained herein is true and correct. Work done pursuanf 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 ci�cumstance. ! am the owner, or l am authorized by the owner of this property fo perform the work for which application is made, <br />and I comply with ihe State Contractors Law 98.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />�z_ � � � ��" ���- ��/i � 3 t ►o o $ - �7 S ? <br />Owner(Authorized Agent Signature Date (Revised 5/20/2016) <br />�� � <br />✓ � <br />