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PERMIT APPLICATIO <br />BUILDIIV�JIECHANICAL / PLUMBING / SIGN RINKLER / DEMOLITIOiV <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 />OWNER NAME: � �6'kM <br />OWNER MAILING ADDRESS <br />OWNER PHONE: y Z� <br />CONTRACTOR NAME; �, <br />CONTRACTOR ADDRESS <br />CONTACT INFORMATION <br />-- � ; �„7 ��� TENANT NAME (If Commercial): <br />sTRee� <br />CITY <br />%OC3Co <br />STREET <br />CITY <br />ey^i["�" STATE �'v `T <br />OWNER EMAIL: b rt �,t hU�-�s c.�,,�c� �� <br />STATE <br />ZIP ! � <br />a �� . C� <br />ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): <br />PRIMARY CONTACT: WNER ❑ CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: �Z,� �j �(j (�, �(� 1 <br />��ti'�-,L l�"�-�� CONTACT EMAIL: ���. �'ll;w, �CT ,`'`u,�� ., <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: 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 />OCIATED BUILDING PERMIT # (if applicable <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixfures Lisf of Fixtures Fixtures Lisf of Frxfures <br />A/C—AirHandling Units HeatPump <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 Lisf of Fixtures <br />Fixfures Fixfures <br />Toilet Backflow Preventer (Inside Bldg) <br />Bathtub Urinal <br />Lavatory (Wash Basin) Drinking Founfain <br />Shower Floor Drain <br />Kitchen Sink & Disposal Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas J� � "� <br />Water Heater Other: Z t:�,(,�. 1y�• <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 musf comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must fi�si be authorized in writing from the <br />Building Official6efore being authorized under any circumsfance. I am the owner, or I am authonzed by the owne� of this property to perform the work for which application is made, <br />and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />� z� ( r� PERMI �� f(��J� r� I <br />�I �i <br />Owner/Authorized Ag nt Si_ ature Date (Revised 90/92/2015) <br />