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���,�, ,��� <br />� - <br />��� <br />PERMIT APPLICATION <br />BUILDIN JIECHANICAL / PLUMBING / SIG�=. 'RINKLER / DEMOLITION <br />CITY OF EVERETT PERMIT SERVI e__ <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 Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: ��� �O � S�� • �J�- D�� � PROPERTY TAX #: 2,�r,J�G�3�o2a'� I�O <br />LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: �, `' �, •� . TENANT NAME If Commercial): � l� <br />OWNER MAILING ADDRESS: sTReET l� ��3. �ry �v 5'p1/l � <br />CITY � e. ST.�TE Q- ZIP � <br />OWNER PHONE: GC.tp- - Zgj�p� OWNER EMAIL: O� %7p.0 C� �cLi, .�S <br />CONTRACTOR NAME; � /�} j�V/�. <br />CONTRACTOR ADDRESS: sTReET 2� �£' �OG� �' . lNH � <br />I <br />CITY ��i�,/ !� l STATE V� ZIP <br />CONTRACTOR PHONE: �'f� I ` O� CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): �1. ��.�'� `r� (-�`�a\'[�,� CITY OF EVERETT BUSINESS LICENSE #(REQUIRED):�' ��j ` <br />PRIMARY CONTACT: ❑ OWNER CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: �/Cc� O �/�� eS CONTACT PHONE: ��Z� -� ��- f'j �� <br />CONTACT EMAIL: �(,fcW ey� /�� ( ij -�j �i �3GL �" . �'-C31y1 <br />BUILDING PERMIT APPLICATION <br />Existing Use of Building: ��/('i Contract Price of Work: $�� ` <br />Proposed Use of Building: � lC 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 ❑Sprin r ❑Demolit�o ❑Change of Use <br />DESCRIPTION O WO K: P� QC�o �C 6� /�� /� C Cvri; � 4s % edv L'vy?. i <br />�-� � <br />,� � ,,�r' c.�. Gl/�, : <br />�'G2 i�!' • �' � Z �i��.( �� � 3 • <br />ASSOCIATED BUILDING PERMIT # (if applicable): /U/� • <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtures List of Fixtures Fixtures List of Fixfures <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 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 (ServicelBar/Mop/etc.) Other: <br />ACKNOWLEDGEMENT: I have reviewed this application and confirm the information contained herein is true and cor�ect. Work done pu�suant 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. I am tlie 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 tlie State Contractors Law 18.27 RCW and 296.200A WFlC. <br />Agent Signature <br />City of Everett Official Use Only <br />PERMI, ,_ <br />-2�� l� / R , �,1 � - �,1� �''l <br />Date (Revised 5/20/2016) �, � <br />