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PERMIT APPLICATIO�i <br /> BUILDIN( IECHANICAL / 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 SIT ADDRESS: PROPERTY TAX#:. _ � <br /> � [� � <{-�`i, �i/.'' z✓t- � ' � <br /> � <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long Iegal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ���„�'-; S�' •� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer ' � '� <br /> U� � <br /> CITY " (� �� � STATE (�� � ZIP v � C.) . <br /> OWNER PHONE: :,p,�2`( � �j� � �3�'j � �'�' OWNER EMAIL: <br /> CONTRACTOR NAME; ) �r�J ' I� <br /> CONTRACTOR ADDRESS: sTREer /��LU �7 (J fL <br /> CITY LJ STATE .�"' ZIP U Z� <br /> CONTRACTOR PHONE: —2_ v CONTRACTOR EMAIL: E� - -, �,v.a,j� L,s� <br /> CONTRACTOR LICENSE#(REQUIRED): ' — "�' �' � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q� ^'1 ,,�;� <br /> PRIMARY CONTACT: ❑ OWNER I�'CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2�r — �3u -- Z 6 <br /> G'bZ-U}-I Cs- � �S� CONTACT EMAIL: �i�:(,a1j_� < ,� <br /> 1"��,�1�.. T�r.� /h i� ���-;�. -,� ; ;.� <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: f7SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition I�Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �Z��v��; ��,� c-L n ���� �-l� � R.�t��►u��.- <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 #of #of #of <br /> Fixtures Lisf of Fixfures Fixtures List of Fixfures Fixtures List of Fixfures Fixtures List of 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 confrrm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,stafe, and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing f�om 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 peiform the work 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 /> C! / ' �/'`, � \ — PERMIT�j�lS/C�� " �lG C� <br /> Owner/r th ri ed Agent ignature Date (Revised 90/12/2095) ,`I� <br />