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PERMIT APPLICATIO <br />BUILDINE ECHANICAL / PLUMBING / SIGN'1rt"RINKLER / 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 />PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: y�d OaI<-t5 ,q PROPERTY TAX #: 2 q a� f� pOZ,DI y(� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �„eiGf t S��oo f ��st�� �/- TENANT NAME (If Commercial): '��,+,;� � E w,;.-��' ��:�_�,_. �� ::.s:�"���'�; <br />OWNER MAILING ADDRESS: sTReeT .�l �100 �o a cL,.va <br />CITY E„� r«-�- STATE W H ZIP /(�/ Z �� <br />OWNER PHONE: ��'I Z,$ � 3 S 5—�( l q5 OWNER EMAIL: ' c, o � �� �5 � e�� � e f-r o(_ o � <br />CONTRACTOR NAME � <br />CONTRACTOR ADDRESS: sTReeT <br />CITY STATE ZIP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): �� � S � CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �l � <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR �.OTHER (Please Specify) �'Q.(��'CE[� <br />CONTACT NAME: CONTACT PHONE: /�� _�is ,., 3` <br />ZJ�(� �1�� CONTACT EMAIL: �(� � O� <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: � Contract Price of Work: $ �,�� <br />Proposed Use of Building: Heat Source: ❑Gas I�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: � �\ �� � x 32/ � '•„ ,,/ , . . _ 1 �J plk(�Q, �Q}��.DDwI � <br />) �....,�.,,�cU(zvc6el� �C <br />� e�.�c�iv�d,� � ct� eS.C�Lx <ow�,�� . �'�. <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtu es List of Fixtures Fiztures 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 Fixtures #°f List of Fiztures <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: l have reviewed this application and con(irm 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. 1 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 the State Conh�actors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />�( (�03-DOZ <br />(Revised 10/12/2015) <br />