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• PERiVIIT �4PPLICATI• <br />BUILDING / MECHANIC.4L / PLUMBING / SIGN / SPRINKLER / DEIt�OLITION <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 Plea e) PROJECT Sll'@ IMF012M/�TION <br />PROJECT SITE ADDRESS: �� M�k � 1t� [�1 I/ PROPERTY TAX #: Q�����i�J�J <br />LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br />OWNER NAME: u�j���f� <br />OWNER MAILING ADDRESS: <br />OWNER PHONE: <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS <br />CONTAGT INFORMATION <br />� /�-�/1% l �.,j � f /i ��� TENANT NAME (If Commercial): [�{c,�" ',/ � y�,�"�'j�i <br />CONTRACTOR PHONE: ��i�i <br />CONTRACTOR LICENSE #(REQUIR <br />PRIMARY CONTACT: ❑ OWNER <br />CONTACT NAME: <br />� <br />STRGET <br />ciTv <br />STREET <br />CITY <br />Existing Use of Building: <br />Proposed Use of Building: <br />Building Type: ❑SFR-Detached ❑SFR-Attache <br />Type of Project: ❑New ❑Addition J$(Remodel <br />DESCRIPTION OF WORK: <br />���� � STAI_E /�' ;?�1 _ <br />--���-• <br />OWNER EMAIL: <br />_ ..,._ _ _..__T _ ._._. __ ,..... ...._... ._ _ ..._ .. . .. .. <br />s�-�.� � �i=3�} �T /r�c�/� ��� � <br />�J � �' �-��' /�y' ,��' � � <br />/ ' �� � � STATE �/� <br />c�ri CONTRACTOR EMAIL: L-���J � <br />� C CITY OF EVERETT BUSINESS LICENSE <br />;TOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: � . .:�� � <br />CONTACT EMAIL: ) C ! � <br />BUILDING PERMIT APPLICATION <br />ZIP <br />ZIP <br />�'/ ��'�n.�,i <br />� <br />Contract Price of Work: $ <br />,� <br />Heat Source: ❑Gas lectric ❑Other <br />d ❑Duplex ❑Multi-Family-# of Units: �Commercial ❑Industrial <br />❑Repair ❑T.I. ❑Siqn ❑Sprinkler ❑Demolition ❑Chanqe of Use <br />�� �r� �/r/ P ,�?��Cd��,�',�'/� t�, �.>f.ti.5�z �y !��'x��� f%/� L-f�'1Z�. <br />ASSOCIATED BUILDING PERMIT # (if <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixfu es List of Fixfures Fi�ures 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 List of Fiztures #°f List of Fixfures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basi�) 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 confrrm the informafion contained herern is true and co�rect. Work done pursuant to this pe�mit must comply with <br />current federal, stafe, and loca! law. The granfing of a permit only authorizes approved work and no deviations iherefrom. 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 ov✓ner of fhis property to perform the work for which applicafion is made, <br />and 1 comply wifh the State Contractors Law 1(327 RCW and 296.200A WAC. <br />City of Everett Officral Use Only <br />� f � .�� PERMIT #i \il � I n � � � � � <br />i � U�� I <br />Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />��z <br />