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t��FiM17' AF'P�ICP,T'IOY� <br /> F3UILDIR:� t iV1�CFi�,�1CAl�I PLIJi�i�I�IG J SIG�' , �'Pf�Ii�KL�R/ ��Il�10�11"10�1 <br /> CITY OF EVERETT PERMIT SERV'" " ' <br /> 3200 CEDAR STREET, EVERETT,WN�JaLU"I <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> _, _. <br /> _ PROJECT Sl'�'E IAIFORIWATION;: " - <br /> ___. . . _: . __. _ <br /> PROJECT S1TE ADDRESS; iy,�i� C"'�' !1,C , PROPERTY TAX#: <br /> '1 J V <br /> LEGAL for new construction: Short Plaf/subdivision Lot No. (attach copy of long legal description) <br /> _ _ , <br /> : , ` - CON`i`ACT INF012MATIO�I -' <br /> OWNER IVAME: f�i�E� U�Z � �/''jJ� TENAPIT NAME(Ifi Commercial): <br /> OWNER MAILING ADDRESS: sTrzeer 7��f � �6 �� �� <br /> 3 l` � s= s�� � .� <br /> - CITY C,u l�J�i(l �J STATE ��✓,�i ZI P eI �' u�� <br /> OWNER PHONE: yZ _j�— 2. �,Z — �/�3 OWNER EMAIL: ,4� C j� ''� �ua . C �/ <br /> , . ,.__.,. .,. .... . .: .. . . .. . _:..:.:.. .: .. .,., . ..: .. :..:. . .. <br /> _. . .. ... :_. :. . . . <br /> ;/CONTRACTOR NAME; %u�%N � C�'��.�1/l y `E•✓C� ��i_ <br /> 1 <br /> CONTRACTOR ADDRESS: sTReEr G S��� 2/� L✓ <br /> C�-�y L � ��,.''[,�uc'/, STATE � +g ZIP C- � <br /> CONTRACTOR PHONE: ��S — 7 7S- ev S �j CONTRACTOR EMAIL: <br /> ' CONTRACTOR LICENSE#(REQUIRED)• l vG-�N�-F��-/ L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): U����-3 <br /> i ' <br /> � ..._.._,...,.:.......... .. .. ...-._,.,,.. .___ _.....�,... .. <br /> ' PRIMARY CONTACT: �OWNER ❑ CONTRACTOR ❑ OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> A�-�� G���L�'�� �� CONTACT EMAIL: <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 ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � � ,�� <br /> '�"' `�' �11'1 I`�/l - ( D° l�i�lvt (',!-�w,��� �I'h� ►����-�✓ - � �M�" <br /> �GLI i'lk. � �I� �'�r�1-t-�'- �'� ' �-'1�.� ��� L�vn,i v� l,�`�Y� ti� �-�`h� w,►� �rA,wt <br /> ASSOCIATED BUILDING PERMIT#(if applicable): � �� <br /> MECHANICAL PERMIT APPLICATION P..LUMBING PERMITAPPLICATION <br /> Type of Project: _New _ Addn _Aiteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisf of Fixtures #of List of Fixfures #�f List of Fi�cfures #°f List of Fixfures <br /> Fixtures Fixtures Fixfures 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 Founfain <br /> Wafer 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 Ofher: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BadMop/etc.) Ofher: <br /> SPRINKLER/SUPPRESSIOId SYSYEM <br /> Number of hieads <br /> ACKNOWLEDGEMENT.�1 have reviewed this applicafion and confirm the inforrnatron contained herein is frue and correct. Work done pursuant fo this permit must comply with <br /> cu�rent federal,state,and local law. The granting of a permit only authorizes approved work and no deviafions therefrom.Deviations must first be authonzed in w�iting f�om the <br /> l3uilding Otficial before Geing aufhorized under any circumstance.1 am the owner,or l am authorized by the owner of this property to peiform the work for which applicafion is made, <br /> and/comply wifh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Everett Official Use Only <br /> I PERMIT�t <br /> � � � y iy. i� r _ <br /> Owner�zed Agent Signature Date (Revised 10/92/2095) � - <br /> ' °�, L <br />