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PERMIT APPLICATIO <br />BUILDINlVIECHANICAL / PLUMBING / SIG PRINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 I FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: i j �� . l � v PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ����� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTReeT �„! ✓l� �'� - _,�-� <br />ciTv -JC;�� STATE � ZIP j����' <br />OWNER PHONE: �ZS �" j J}^ S OWNER EMAIL: � a��-; b.w�� c��, �' v1 � Corr <br />CONTRACTOR NAME; <br />CONTRACTOR ADDRESS: sTReEr <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE (REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: OWNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: v'�c�- SJ ``� �S S„� <br />,��'�� a.V � CONTACT EMAIL: C;���,�w�-,� w �.,,� �1 ,�aY�� <br />BUILDING PERMIT APPLICATION <br />� � �;. <br />Existing Use of Building: J• Contract Price of Work: $ ��. � <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: <br />�... ;, 5� ��,\ �n e �„1 -s'�. r n c; � �e `t� he�=;� �-,�►-,� �' ��,�-- �t;�C'S`�✓ �ti'�Y�l/ <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fi tures Lisf 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 Lisi of Fixtures #°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 />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 t�ue and cor�ect. Work done pursuant to this permif must comp/y with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must firsf 6e authorized in writing from the <br />Building Official before being authorized under any circumstance. ! am the owner, o� I am authorized by the owne� of this property to perform the wo�k for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />Agent Signature <br />City of Evereit Official Use Only <br />- PERMIT# � n � � �,�� ` � ,, <br />'l � U <br />Date (Revised 10/12/2015)!.^� � <br />l!/ "J . D � <br />