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��V�P�ii APP�iCAT90h� <br />BIJILDIf� IIfiECHAPd1CAL / PLUYVIBING / SO(9�RINKL.E1� / DEPViOLITION <br />CITY OF EVERETT PERMIT SERVI � <br />� 3200 CEDAR STREET, EVERETT, WA 98209 <br />(P) 425-257-8810 � FAX 425-257-8857 �(E) everetteps@everettwa.gov � www.everettwa.gov/permits <br />COla17'ACT INFORMA'iION <br />OWNER NAME: ��,� � �� �� �� TEidANT NAME (If Commercial): �G,sy-- �R� /�r� . <br />-� .. : .: . . <br />. ; , <br />OWNER MAILING ADDRESS: srrzee-r � � ' +_, `. � ` � <br />� f��� � . ,. ' _" `' <br />cirr V���P� 5' ar� srare �� ziP ��� <br />OWNERPHONE: � ��' ���j� ��� OWMEREMAIL: �9��i�t��l�J�� � ('��g`'�t�Ce�`it�' . iN1 <br />CONTRACTOR NAME: <br />CONTRACTOR ADDRESS: sTRe�r <br />GTY STATE ZJP <br />CONTRACTOR PHONE: CONTRACTOR EMAIL: <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #{REQUIRED): <br />PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER {Please Specify) .7v �e�� �C�T , <br />CONTACT NAME: �' '�'fl;��" ��' ����> CONTACT PNOIJE: d,fa� _�S� ��� <br />,C c.�3� �p�'i` � e�T✓'r7i'�' i�.+�Cii�1Ys'_•� - <br />/ aRRL-S� ��w'�.� CONTACTEMAtL: F��RGSiJOl��SCJ�orrGas�",ld�� <br />BUILDING PERMiT APPLICA�ION <br />Existing Use of Buiiding: �G q,� T•�d Mt��f�,c. +A Contract Price of Work: $ % <br />Proposed Use of Building:�v�v d�✓E' �%� yo� E fi ea# Source: L�c�as ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ommercial ❑Industrial <br />Type of Project: ❑New �Addition ❑Remodel ❑Repair .I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />��. �"�.-�:' �' F"x T: -�ar ....����o. w�,..� 6� .�..c �J �.�, : �.Sp.�.7�--.� - <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 /># of List of Fixtures # of Li of Frxtares # of List of Fi�rtures # of ' of Fiutures <br />Fi�rtures Fi�ctures Fixtures Fixfures <br />/ A/C — Air Handling Units Heat Pump ,.S' Toilet 9 B ow Preventer (Inside Bldg) <br />Forced Air Systems Unit Heater Bathtub / rinal <br />Gas Piping ,I R- Boiler � Lavatory (Wash Basin) Drinking Fountain <br />! Water Heater Refrigeration Shower Floor Drain <br />Gas Fireplac ` Wood Stove � Kitchen Sink & Disp 1 Grease Trap <br />Gas Ra Ducting / Dishwasher (; Roof Drains <br />,/ Ciot s Dryer Hookups Other: / Clothes W er Medicai Gas <br />nge Hood p Water eater Other: <br />� Exhaust Fan �/ Si (Service/BadMop/etc.) Other: <br />SPRINKLER / SUPPRESSION SYSTEM <br />Number of kieads <br />ACKNQWLED�EMENT; ( h�v� revi�wed thi� appLiCation an�l Gpnfqm th� info.r.rr�atlop C4ntain�d hereln i� trge and cp�r�ct. Wprk d4n� pur�uant to th�s perm�t must Comply With <br />current federal, state, and local /aw. The granting of a permit on/y authorizes approved work and no deviations therefrom. Deviations must frrst be auihorized in wrifing from the <br />Building Offcial before being authorized under any circumstance. I am fhe owner, or i am authorized by the owner of this prope�fy to perform the worlc for which application is made, <br />and � com�ly with the Stafe�, ntractors Law 98.27 RCW and 296200A WAC. <br />����• �s '-�s- .zvl6 <br />Date <br />City of Everett O�cial Use Only <br />PERMIT# <br />�l�o�- 6s3 <br />(Revrsed 10/12/2015) <br />