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PERMIT APPLICATIOII <br />BUILDINC ECHANICAL / PLUMBING / SIGN '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 SI ADDRE • , PROPERTY TAX #: <br />+c �G� /� �C " 'f� <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />� ,c <br />OWNER NAME: ST, �'en`�'T ,l�= %�¢u' � TENANT NAME (If Commercial): ��' � �/���C-�vi ✓-�' /`�/��C..0 <br />OWNER MAILING ADDRESS: srREET ,� jD ,�?J�U�{.� ,?-,✓ <br />C'� ��`�G( � CITY STATE ��/ ZIP �Z C� ) <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTORNAME: %�UDi+�S��'"1 /���c,�O��t -r <br />CONTRACTOR ADDRESS: sTREEr;�C �� (J /Z � rrc �? t- <br />CITY ���1 r-if c Cl�yf STATE �C%v/ ZIP �� �? J� <br />CONTRACTOR PHONE: �Z� � 7J �f •- �/{� " CONTRACTOR EMAIL: �j�f ���� ,L!�,1 /�—l/�� ,o �`(i�� <br />CONTRACTOR LICENSE #(REQUIRED): �O L%/Y( J� � �' CITY OF EVERETT BUSINESS LICENSE #�REQUIRED): � <br />PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: � y { _ ?� — (� ^7 / � <br />��G��fr'%G�� ��,� CONTACT EMAIL: y ri /=U � I�/°-L l�/TC'- ��;�-'' <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: �� 1���� Contract Price of Work: $`�S U�`i� <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: � �� r�- �� fj��rr�''? ✓ � <br />��?�v 1 2— Q c ,�Jzw �ce���e�� <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /># of Lisf of Fixtures #�f List of Fixtures # of List of Fixtures # of List of Fixtures <br />Fixtures Fixtures Fixtures Fixtures <br />A/C — Air Handling Units Heat Pump � Toilet Backflow Preventer (Inside Bldg) <br />Forced Air Systems Unit Heater Bathtub Urinal <br />Gas Piping Boiler � Lavatory (Wash Basin) Drinking Fountain <br />Water Heater Refrigeration Shower Floor Drain <br />Gas Fireplace Wood Stove � Kitchen Sink & Disposal Grease Trap <br />Gas Range Ducting Dishwasher Roof Drains <br />Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br />Range Hood Water Heater Other: <br />Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of Heads <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply witli <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 autho�ized under any circumstance. 1 am the owner, or 1 am authorized by the owner of this property to perform the work for which application is rnade. <br />and I comply with fhe State Contractors Law 18.27 RCW and 296.200A WAC. <br />-Z-Y-I J'� <br />er/Authorized Agent Signature Date <br />City of Everett Official Use Only <br />PERMIT # <br />_ o � <br />(Revised 10/12/2015) <br />