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P <br />PERMIT APPLICATION <br />BUILDIN�ECHANICAL / PLUMBING / SIGN �RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVIC <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-881 D � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />ADDRESS: ��� � ����;���-j���.� PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision <br />Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �'� ���V ��-� �'-= f'"� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReer �!` r-������'-�'�= (�� i�''� ra'-�- <br />crrv <br />NiI^��'I�ti�S� STATE l..�i�-- ZIP (��%����I <br />OWNER PHONE: � �� '� � ! • �� � �-��' OWNER EMAIL: ��-$ t � l=--t �,7G` G�t-t � d a �...� _ �GM <br />CONTRACTOR NAME S -C<-�F ��-'��z 6���= s+�=�=+ �!�- - � ;��1- . <br />CONTRACTOR ADDRESS: sTReer P•C`' �%� 7���� `� <br />CITY �ii 7.� i�l.,..i� STATE f�� � ZIP JG�� �1�� <br />CONTRACTOR PHONE: Z � � �-��%t�'-% � I � � CONTRACTOR EMAIL: -=�E��k- �= ! � � �--�=�-=��=���'C'C' _ �Gt--1 <br />CONTRACTOR LICENSE #(REQUIRED): i_�La�hj�.�-�:-���i ��(e.� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): C'����J� <br />PRIMARY CONTACT: ❑ OWNER O�CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: ZC'f.� - Z�S ���P �� <br />( �,Q v � ��-;C� 2'.= N� �z� <br />CONTACTEMAIL: �1�il���-�-��P�-�CC- ���"1 <br />BUILDING PERMIT APPLICATION <br />� <br />Existing Use of Building: (� �t`-''� ���-- Contract Price of Work: $ ��:� 4 G- <br />Proposed Use of Building: �='�l �'"tF= Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: �SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type af Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: �-���� G�-� ,� �� _�����-�— �' ��.� ������- �-�l= Gn� r��l����-�� <br />��- 2r-�� '_-�-'� CL C�- t i� � �... �� t�.d � t-1 r c�=- . c�=�..._._/ <br />C���''���� <br />ASSOCIATED BUILDING PERMIT # {if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fi tu es List of Fixtures Fixtu es 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 Drver Hookuos <br />Range Hood <br />Exhaust Fan <br />Heat Pump <br />Unit Heater <br />Boiler <br />Refrigeration <br />Wood Stove <br />Other: <br />PLUMBING PERMIT APPLIGATION <br />Type of Project: _New _Addn _Alteration _Repair <br />Fi tures List of Fixtures Fixtu es Lisf 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 />SPRINKLER / SUPPRESSION SYSTEM� <br />Number of Heads <br />ACKNOWLEDGEMENT.� I have reviewed this application and confirm the inlormation contained herein is true and correct. Work done pursuant to this permit must comply with <br />current (ederal, 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. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />- _� <br />_ i' <br />, _ 1 ��.._ <br />Ownerl4�uthorized Agent Signi <br />' j-}�- <br />L�l!--_ _- .� . ? _� . i f <br />Date <br />City of Everett Official Use Only <br />PERMI� � � �) � J � � , <br />(Revised 10/12/2015) <br />