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PERf1�IT APi'LICA.l'IOA� <br /> BUILI�I� iVIIECHANIGAL/ F'LUfV1BING /SIGN ' '�INKLF_R i DEiUIOLITI�N <br /> CITY OF EVERETT PERMIT SERVICts <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 /> ,... <br /> , -. �_r�o.��cT si-r� ar�_�o�m�rr�o� : .: <br /> :::. _ :.:.._. -. :�._ .. , <br /> PROJECTSITEADDRESS:���� ��� ����;�;�� �ROPERTY"fAX#:��t.{�c'� Z/Z�c� �j � ��,� <br /> LEGAL fof new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> , .:.. _ � - <br /> ,. <br /> .: :..,_ <br /> ,..,COIPIYAC'F;MN�QF2MAYIOCd <br /> _ _... _ <br /> OWNER NAME: [L1�/L-L. �������� TENANT NAME(If Commercial): <br /> OWNER MAILING A�pRESS: srReer 1 Z�� �.L1 j�'�'�l�-���� /�4-�r <br /> crrv L G�� �,�'�.'� STATE t,�Lrt��7' ziP �����'--�,A <br /> OWNER PHONE: Z(-y 7� -'�LE�l OWNER EMAIt: <br /> CONTRACTOR NAME; �fNN��'�— _, . _ <br /> CONTRACTQRADDRESS: srReFr --- �-- `-v <br /> �' <p f,�-r--'Z- <br /> CIIY STATE a-"�����`"� ZIP l �� -^ <br /> GONTRACTOR PHONE: 3 L�C� - >�Z--- '��'%�C CONTRACTOR EMAIL:c. <br /> CONTRACTOR LfCENSE#(REQUIRED): C1TY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRlMARY CON7ACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: fj�t��J j�j�/����f'i!"f CONTACT PHONE: �G3�i - j���_-���Z�� <br /> CONTACTEMAIL: ���(,�i �.�-)!~=r�S`G°��i��'~� �'�� <br /> „ . -_ : - <br /> ' -= � BUiLD1.NG,PERNi1T:APPLICATION. ' . - - <br /> Existing Use of Building ��f�� Contract Price of Work:$ � f r �'�� �' <br /> Proposed Use of Building: ��G`m-4����=`�� Heat Source: C1Gas ❑Electrie DOther ���t� <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: C1Gommercial ❑Industrial <br /> Type of Project: l"�lew C�Addition [�Remodel L7Repair I�T.I. C1Sign OSprinkler ClDemalition OChange of Use <br /> DESCRIPTION OF ORK: ,, � ' �� �"` �;.�c_�.,,i ) G yL.`.=t r:t('-� C"v�'d d�-d-+-�-"Z< <br /> ,^� ,_n C:G:�Ita S i-���% i--T"����, c'��i� I'�- �L ��. <br /> WY�� <br /> f����VV1;PJl� �6l�INl�. -�1d�.f���-�C-���--1,�- ' _ - - �-�, -Gt t�-�—'h_���- - <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> _ _ <br /> - - ` PLU'MB N:G� ERMIT APPLI'CATION. <br /> ` ;MECHANICAL PERMIT APRLICLITIDN:' ;: - <br /> Type of Pro�ect _New_ Addn AiteraY�on _Repair #�e.�€� c �ew ____Addn _Alteration _Repair <br /> #of �°{ List of Fixtures #°f List of Fixtul'es <br /> List of Fixfures ��f List of Fixfures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC-Air Handling Unifs Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> For�ed Air Systems Unit Heater Bathtub � Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Founfain <br /> Water Heater Refrigeration Shower Floor Drain. <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range <br /> 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. �,�,� � ',f�'�- '• i� <br /> , <br /> ;`1` f ';` �a <br /> . . �' �.. <br /> SPRINKL�R/`SUPP:.RESSION;SYSTEM:: .c, �- <br /> Number of Heads <br /> ACKNOWL[DGENENT.•1 have reviewed this appiication and confirm the informatron contained herein is true and correct.Work done pursuanf to fhis permil musf comply with <br /> current federal,sfate,and local law.The granting of a permit only authorizes approved worl<and no deviations fherefrom.Deviaiions must first be authorized in writing from the <br /> eui/ding Official before being authorized under any circwnsfance.l am the owner,or!am author'ized by the owne�of this property fo perform the work for which application is made, <br /> and/comply with the State Contractors Law 1t3.27 RCW and 296.200A WAC. <br /> Cify of Everett O�cial Use Only <br /> `- � ` PERMIT# <br /> �•�. ��� ` � _ ...�._ ,;� a- 1 r� =L t. ;�-, � r .�. l� <br /> ,���.`__ �:..� --j��-=v=�'~-� <br /> O ner/Authorized Agent ignature + Date (Revised 10/9212095) <br /> �,�►'Vw S -� '``i�� a►�� '" - l '�''`V" 1 ^r �r �� - <br /> ll � � � �� � <br /> �U� l�.Ot01�c� ' ' <br />