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PERMIT APPLICATIO <br />BUILDIN�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 />(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br />PROJECT SITE ADDRESS: � �� ��- ��',�,'�`_��- ��'�C�L.��� �-��� RO,PERTY TAX #: <br />LEGAL for new construction: Short PlaUsubdivision Lot No. ach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: ��� TENANT NAME (If Commercial): <br />OWNER MAILING ADDRESS: srReeT2� � �,�L'��/ ��,'�:���C�� C�'�L�L�/ <br />CITY '-7/ � ���� STATE P�'� <br />L <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: , /j , `� l d/� .� �l <br />CONTRACTOR ADDRESS: srReeT ��% ��; V ,-{� �,f�,�'1'Z",;'�,� Q'� <br />CITY <br />CONTRACTOR PHONE: �"� ��-� � �l <br />CONTRACTOR LICENSE #(REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER I <br />CONTACT NAME: --�. <br />��"���'�,�� ����� <br />ZIP <br />i �, <br />%; � Y�`�t` STATE �� �" ZI � )� �i-� <br />Cl��j� x. �I y CONTRACTOR EMAIL: <br />` �` .j� �''��/j CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): �j"� <br />CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT PHONE: 1-��� ��,,5's�"-�S`�� �L_ ���- <br />CONTACT EMAIL: E; lt�'��.i'�f�" I/�o ai,,r �1`;�, n fi: ��-,ts,,,.� :r,-... <br />BUILDING PERMIT APPLICATION <br />Kisting Use of Building: Contract Price of Work: $ 7 �' b <br />roposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />ype of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. �7Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />ESCRIPTION OF WORK: c <br />t Y l ���-�=�� �- l. �-' � "� ���'� '�' ��' .� <br />� <br />TED BUILDING PERMIT # (if applicable): <br />MECHANICAL PERMIT APPLICATION <br />Type of Project: _New _ Addn _Alteration _Repair <br />Fixtu es List of Fixtures Fixtu es 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 # of List of Fixtures <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: 1 have reviewed this application and confirm 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. I am the owner, or 1 am authorized by the owner of this property to perform the work for which application is made, <br />and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br />n <br />� City of Everett Official Use Only <br />% PERMIT # <br />�� � ��'�� �� ������"�� <br />Owner/Authorized Agent Signature Date (Revised 5/20/2096) � d� <br />r <br />P' <br />