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PERMIT APPLICATION <br />BUILDING �CHANICAL / PLUMBING / SIGN I�INKLER / 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 />PROJECT SITE INFORMATION <br />ADDRESS: i531 L�-lP�(���C�AV� <br />LEGAL for new construction: Short PlaUsu <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: M� �� �� M TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT g l( t--��1�(Y�� DQ�J� N� <br />CITY <br />%� I-' ��%�/� �� STATE W�' ZIP ��� Z 1 I <br />OWNER PHONE: 4 ZS • 'Z� 1 • Q-(���% OWNER EMAIL: �� � ��'"� �OG �M � � � - �CM <br />CONTRACTOR NAME LCC��N�' 2CCF �►��G—i CG -� tJC • <br />CONTRACTOR ADDRESS: sTREeT P•� � P�X �1 �J l Z4`� <br />CITY Pu �a c�P STATE U�P � ZIP �v� �� <br />CONTRACTOR PHONE: ZS J� '�J4� � l�—I CONTRACTOR EMAIL: ����'�� C�������- GO� <br />CONTRACTOR LICENSE #(REQUIRED): LF���f�l(ZC--9�4 �N CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): O4�Z�J� <br />PRIMARY CONTACT: ❑ OWNER C`�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ZCYo - Z SS `,�' '1 � Z <br />�A� L �����C ��� CONTACT EMAIL: C�i�-'1�' C C-L-����-�C-G • COF�� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: ���� 1-- Contract Price of Work: $ ��,�42 _= <br />Proposed Use of Building: �� M� 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: -r�A(� C�F ��� _�H �CT-- � r!G �T�!-�2 CFF O� G--�,�e�C--,E, <br />� -�', � �� - (Z_CaC� �� C1 �i �-i F� � -�-� CGN ��,-' N r �C'-� �.� <br />{ <br />ASSOCIATED BUILDING PERMIT # (if applicabl <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixtures Fixtures List of Fixtures <br />A/C - Air Handling Units <br />Forced Air Systems <br />Gas Piping <br />Water Heater <br />Gas Fireplace <br />Gas Range <br />Clothes Dryer Hookups <br />Range Hood <br />Exhaust Fan <br />Heat Pump <br />Unit Heater <br />Boiler <br />Refrigeration <br />Wood Stove <br />Other: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Fiztures List of Fixtures Fixtu es List of 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 />ACKNOWLEDGEMENT. 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to tn�s permit must compry witn <br />current federal, state, and local law. The granting of a permit only authorizes app�oved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Burlding Official before being authorized under any circumstance. 1 am the owner. or I am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />� 2-2�•t( <br />OwnerlAuthorized Agent ' ia�ure� � Date <br />City of Everett Official Use Only <br />PER�IT # <br />�'� ( (c� �' � — U `�� <br />(Revised 10/12/2015) <br />