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PERMIT APF'LICATION <br />BUILDIN�ECHANICAL / PLUMBING / SIG�RINKLER / DEMOLIiION <br />CITY OF EVERETT PERMIT SERVIC <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 Anly Please) PROJECT SIiE INFORMAiION <br />PROJECT SITE ADDRESS: �� LIn .. - �., - PROPERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: � }'� y� ,� ��;,�� , TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: sTREET ;�� V S Lct �� <br />CITY �� �'Z Q� STATE ,J � ZIP �� , � V <br />OWNER PHONE: OWNER EMAIL: S I�: J 1"� /�k �-' ��u ' � vu .co' <br />CONTRACTOR NAME; �T � ` <br />i� S SeR .c�e <br />CONTRACTOR ADDRESS: srREEr � � � '(� � � � ���'�1 F ''�l �i <br />CITY �'LC,L� ` L,�,� STATE ✓ 4'� ZIP �-� <br />CONTRACTOR PHONE: (�j 1 � L <j c CONTRACTOR EMAIL: ��jL.�� � � � � ,� _� c:, �q �/'{ , I , � ��.'-c <br />CONTRACTOR LICENSE #(REQUIRED): � �� S�� Y��- (� I CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): i� 'j �, 'j <br />PRIMARY CONTACT: ❑ OWNER Iy�ONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � �, � � '� �r � _ r J � <br />\J ��''� S�-t:�� t' �.. CONTACT EMAIL: �`� C_.i:.� i r�. `7 '7 L �ti'1 /� I I+ C�l�'� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: Contract Price of Work: $ _� �= cj ^. � v �� <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 />K C' d� � V�� C F= C�C r.. �' S h��� �r C� O� � � N�� C?� �, (� ��j w c c; �� U U P� S�� '( <br />S �� c� c�"� i.`j 'V ``M � � rv' `'� `, � c �-.-r•. 4� ,� V � \ � � �� <br />ASSOCIATED BUILDWG PER I#(i applic ble): �-�� Cs� � S� <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures Lisf of Fixtures Fixfu 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 APPL.ICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of List of Fixtures #°f List of Fixfures <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 informafion contained he�ein is true and correct. Work done pursuant to this permif 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 firsf be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or l am authorized by the owner of this properfy to perform fhe worf< for which application is made, <br />and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />� PERMIT # <br />� '��' - �-- C..,- � I (P D `� - � �J <br />Owner/Auth ri ed Agent Signature ' Date (Revised 5/20/2016) <br />