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PERMIT APPLICATION <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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �� J��� �J/,�' �/// , / � PROPERTY TAX#: J�.���q/��C',,�! .�UC� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTRee1 �� t�l GL'�S J��/G�L� ���'� --�jZi/ �� <br /> CITY C �'��-� STATE �f�- ZIP ��L <br /> OWNER PHONE: �.✓�� `�%� ' /l� OWNER EMAIL: Y�j� � � ,•����� . /� � <br /> CONTRACTOR NAME: ���j /j� ,�j�"� U � 1/C,1 <br /> CONTRACTOR ADDRESS: srReer �j� � � /�I/�j/'��L''� -lj L'"l � r�� Z <br /> CITY Kl��.�.��L7 STATE ////� ZIP �` �J�� <br /> CONTRACTOR PHONE: 2•y�Gi - �j2,-�" '��' � CONTRACTOR EMAIL: �� iJ �j/�/�/ 5 — G' � [�Jf�/J <br /> CONTRACTOR LICENSE#(REQUIRED): �e('}``J �/ � � �j 3 C� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)��57[G'Z <br /> PRIMARY CONTACT: ;�OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ��� ���_���/� CONTACT PHONE: ��%. ���� • �/`�� <br /> CONTACT EMAIL: ��Jl��/ ! � � ���� - �� <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: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler emolition ❑Change of Use <br /> DESCRIPTION OF WORK: ���.�,����.� ��� �.— �� ��i � .���/�� J�J�L�-�/ <br /> � �"� �'x, ���7�1/,�, <br /> l"f//����I,���i �J����c l'� �i� ����'/-� �� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): JI/ � , � / <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #�f 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: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 6e authorized in writing from the <br /> Building O(ficial before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this p�operty to perform 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 OKicial Use Only <br /> PERMIT# <br /> � ; � ,�- � ,.1� �( �D�-C�D I <br /> Ow /Authorized Agent Signature Date (Revised 5/20/2016) i ��� <br />