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• PERMIT APPLICATIO� <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 />CONTACT INFORMATION <br />OWNER NAME: � C� �v����J/ L� � TENANT NAME (If Commercial): (��/ � <br />OWNER MAILING ADDRESS: sTREET �[t� C//�I UL�iQSI/ / S o��o7b <br />CIIY �E��GE STATE /� ZIP ��j� I <br />OWNER PHONE: <br />ONTRACTOR NAME: /�f �'�G /�/ <br />ONTRACTOR ADDRESS: sTREEr <br />OWNER EMAIL: <br />5 /f�'�' `� sT - <br />CITY � STATE � ZIP ��/ J � <br />CONTRACTOR PHONE: p7i7Fj � I�� IC CONTRACTOR EMAIL: �� ����/��p�J'1 <br />CONTRACTOR LICENSE #(REQUIRED): ,Q/��b �*� O/ aCNC CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): ���7� <br />PRIMARY CONTACT: ❑ OWNER �'CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: �� CONTACT PHONE: �(� �'p' � ��' �� <br />�l/�� ��/`" / CONTACT EMAIL: i,I n n nit i11 � J1 n/.', <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: /V(� G/�l/�/I/�� Contract Price of Work: $ O?� ✓�L� <br />Proposed Use of Building: a G/`} � 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: ��s rr p l�- � Ta�9 G� �C� �/1O �x%�%ON � Gv�%J.E�I'�Y�S� <br />l� <br />S��C� <br />ASSOCIATED BUILDING PERMIT # (if applica <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixtures Fixfu 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 />� <br />PLUMBING PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br />#°{ List of Fixtures # of 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: 1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant 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 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 I comply with th�ate Contractors Layv 18.27 RCW�and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT #' � <br />r <br />(Revised 10/12/2015) �� <br />z <br />\ <br />