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PERMIT APPLICATION <br /> BUILDIN�ECHANICAL/ PLUMBING /SIGN / I�INKLER/ 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 /> _ __ .._:- <br /> _ _ <br /> PROJECT SITE ADDRESS: S•a� ?a S �� PROPERTY TAX#: ��'C V �� �-� <br /> � J <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ._ <br /> CONTACT IN.FORMATION: <br /> OWNER NAME: !t1 k� �l.�J{" ANT NAME(If Commercial): /Ul9►'�'1� <br /> OWNER MAIUNG ADDRESS: sTReer � <br /> SNO� �,� ►'�1 C cin' w •Y STATE �- zia �' <br /> OWNER HONE: OWNER EMAIL: <br /> .. ...... . . ........ ..�., _..... ... .__.. ..�. . . ..._... <br /> w.�.. ........ ...... . .. .. ..... .. . .. .... <br /> CONTRACTOR NAME: I /7 10 1 1 <br /> CONTRACTOR ADDRESS: sTReer 7� <br /> CITY � C�� STATE ["V ZIP <br /> CONTRACTOR PHONE: �las �d 7� � CONTRACTOR EMAIL: C� — IO � CO <br /> CONTRACTOR LICENSE#(REQUIRED): � S CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): . S�� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CO CT NAME: CONTACT PHONE: � <br /> � l ,j� ��,►��(� CONTACT EMAIL: <br /> : ; <br /> BUILDING PERMIT APPLIGQTION � <br /> _ ._ ) <br /> Existing Use of Building: 5� Contract Price of Work:$ / � Q ��u� <br /> Proposed Use of Building: Heat Source: ❑Gas �Electric OOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex C7Multi-Family-#of Units: ammercial Olndustrial <br /> �T pe of Pro'ect: ❑New ClAddition f�Remodel �7Repair �T.I. C7Si n �Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �p� r�w S7o1� G�$ AC c�t,,��� Wr��, �t,��� �Ps /��D G A� �,� -�� �w <br /> ASSOCIATED BUILDING PERMIT#(if applicable): � �pl� <br /> �. <br /> ` MECHANICAL PERMIT APPLICATION :! ;: - PLUMBINGr PERMIT APPLfCAT10N <br /> Type of Project: _New�„ Addn _Alteration _Repair Type of Project: _New _Addn _Aiteration _Repair <br /> #of Lisf of Fixtures #�f List of Fixtures #of �ist 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 Urinai <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/Mo /etc.) Other. <br /> SPRINKLER/.:SUPP ES .,. N SY$TEM ` : . : <br /> Nu e of Heads <br /> ACKNOWlEDGEMENT.•I ha e rev' ed this applic tion and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> current federai,state,and 1 al la T e granting of permit only authorizes approved work and no deviafions therefrom.Deviations must first be authorized in writing from the <br /> Building Official before be'g auth riz d under any rcumsfance.I am the owner,or I am authorized by fhe owner of this property to pertorm the work for which application is made, <br /> and l cnmpiy with the St te Contr ct rs Law 18.27 CW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � l/ `� PERN{JT,#� ��l rOV <br /> Y l /l/( <br /> Owner/Authori Agent ign re ate (Revised 10/12/2095) <br />