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� <br />� <br />� <br />PERMIT APPLICATIO. <br />BUILDIN�ECHANICAL / PLUMBING / SIG RINKLER / 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: PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �� % �' L L� 1�/� L�2 f� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREET I j, �+ �j� l_� �/yF� (,'!� <br />CITY �' � � � % {� STATE � �' ZIP �� � � <br />OWNER PHONE: �"% 2 J' z�� C'• Z �� � OWNER EMAIL: �j �% . L� Z�"/ �� C� (• C e� 1'� <br />CONTRACTOR NAME: �'�j%�� <br />CONTRACTOR ADDRESS: sTREET �' �� �'�i ZCiN /A /`'-I l� 4� <br />CITY ��' ���/� STATE �"' 7 ZIP L�� ZU� <br />� <br />CONTRACTOR PHONE: 2 `7 — � ��t- Z � �� CONTRACTOR EMAIL: �'f(/ . (r' ( �(��� �/ ��Ci L• �'> � <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER (Please 5pecify) <br />CONTACT NAME: �� � �� j L,•9 �1�;;� � � � CONTACT PHONE; � �j -- � � J � f� U � <br />CONTACT EMAIL: ��;o��L� j ��/� ���� � . GUG''�-j <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ ���i �Q �� <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 epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: � � � <br />� ��.�� ���, 1 <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 Lisf 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 Fixfures #°f Lisf 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 />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 coniained herein is true and correct. Work done pursuant to this permit must comply with <br />airrenf federal, state, and local law. The granting of a permif only autho�izes approved work and no deviations fherefrom. Deviations must first be authorized in w�iting 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 Confractors Law 98.27 RCW and 296.200A WAC_ <br />City of Everett Official Use Only <br />�� PERMI��� � � � <br />k � � <br />(Revised 5/20/2016) � f <br />� <br />