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PERMIT APPLICATIO <br /> BUILDINU I MECHANICAL/ PLUMBING / SIGN / SPRINKLER / 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- ���' � �� .''4'Y-, PROPERTY TAX#: <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): ,,���o?� "" <br /> OWNER MAILING ADDRESS: sTREEr /�""�.Z.�-" �y.����'� ,��f;^ <br /> L(�� CITY ���� STATE ZIP �f�"LG" <br /> OWNER PHONE: C/Z S- Z � � - �= ( OWNER EMAIL: <br /> CONTRACTOR NAME: /�I-�� p�v�'l�°/C-.,�sL1 f`(�� l i � /� f� :���61 �'l��"�- <br /> CONTRACTOR ADDRESS: srREET �ti �.�c�� � <br /> �(/ � CITY � � STATE Cl ��� ZIP <br /> CONTRACTOR PHONE: ���1 -.��,�' %�j CONTRACTOR EMAIL: a,li�.-'%��F�� �i�/;..1�I �/( � �*J L v'o'L <br /> —!` ' <br /> CONTRACTOR LICENSE#(REQUI �: ��� CITY OF EVE:RETT BUSINESS LICENSE#,R�QUIRED): \ <br /> PRIMARY CONTACT: ❑ OWNER �td��-RCTOI��I OTHER(Please Specify) — <br /> CONTACT NAME: CONTACT PHONE: (,�Z j�. �� �-,�f �/(� <br /> ����,,� ' ?,E�:��,,�rLl CONTACT EMAIL: � ,_��j;� -�r�/f:=.�i1_._ ���'P C' ,./�(iC- r C G��°-� <br /> BUILDING PERMIT APPLICATION <br /> �_._ <br /> Existing Use of Building: Contract Price of Work: $ f,f��' � <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 Proje t: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DES I F WORK: ,/� � / � � / <br /> �I�ic;r���2`�. �/.J�� c�L'�lh(CA � ���j'�i f/.�G U/�i S�f 7` F�� <br /> r _,, - n_ ,, � <br /> �G I�—� `�1'�`�( �O�l l.-L �C�-r'`' l ��,j��^�� . <br /> � � <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 /> #�f List of Fixtures #�f List of Fixtures #°f List of Fixtures #°{ List of Fixtures <br /> Fixtures Fixtures Fixtures Fi�rtures <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 easin) 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 /> SPRII�k1�-LER/ SUP SION�-$YSTEM <br /> � Chemical o Water` No. of Heads <br /> ACKNOINLEDGEMENT have r, 'ewed 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. gCanting 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 I 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 /> City of Everett Official Use Only <br /> P�RM T# � <br /> ,�'�/'_- �-Z�"'_�, � il <br /> Owner/Authorized Agent Signature Date (Revised 23/2016) / <br /> i <br /> � <br />