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PERMIT APPLIC.A.T - ".n <br /> BUILDIim�1 MECHANICAL 1 PLUMBING 1 SI PRINKLER 1 DEMOLITION <br /> OL CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-267-8810 ( FAX 425-257-8857 j(E)everetteps@everettwa.gov j www.everettwa.govlpermits <br /> 1 <br /> �U�err( ail 'Ilr:nts®�vl< (�D� i��p 16dDtSf .�llB llCIli°®IM1tlli®i�V. :- <br /> (. <br /> P _ rVROJECT SITE ADDRESS: ' 17JLI PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivlslon Lot No. (attach copy of long legal description) <br /> OWNER NAME- Abw TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; A& <br /> CONTRACTOR ADDRESS: STREET 2-1 7—C,> <br /> CITY � 7a.en STATE ZIP `6 <br /> CONTRACTOR PHONE: (LrZS) '27522— ((4- CONTRACTOREMAiL: t�CS�._��SSV►'it���` �� <br /> CONTRACTOR LICENSE#(REQUIRED): C--Ve(Z s, 60rz CiTY OF EVERETT BUSINESS LiCENSE#(REQUIRED): �R <br /> PRIMARY CONTACT: ❑OWNER x•CONTRACTOR 11 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> :y <br /> _BUILD.1TtG.PRlNI ':iPPLIGAT1®N <br /> E>cisffng Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: Gas ❑Electric ElOther <br /> Building Type: FR Detached ❑SFRAttached C1Duplex []Multi-Family-#of Units: ❑Commercial OIndustrial <br /> Type of Project: ❑New OAddition DRemodel epair ❑T.I. LISfgn ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:" ,_„--� <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> 6tIlE��itAi�! ` T� �iPAL:PERMIT- LfPOkVbA ®M <br /> Type of Project: _New _ Addn Alteration —Repair Type of Project: _New Addn Alteration _Repair <br /> #of Lfst of.Fixtures ffiof List of Ffxfures #of List of Fixtures #of List of Fixtures <br /> Fixtures Ffxfures I Fixtures <br /> A1C—Air Handling Units lHeatPump JTollet Backffow Preventer(Inside Bldg) <br /> Forced Air Systems JUflitHeater JBathtub Urinal <br /> Gas Piping lBoiler Lavatory(Wash Basin) I Drinking Fountain <br /> Water Heater I Refrigeration IShower IFloor0rain <br /> Gas Fireplace lWood Stove I I Kitchen Sink&Disposal I Grease Trap <br /> Gas Range IDucting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Ser0ce/BarlMopletc. 10ther. <br /> `:' IP) ➢7dl L /$9P F'99g!gl(®_.M:SYSTEM. . <br /> Number of Heads <br /> ACKNOWLEDGEMENT'I have reviewed 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.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officialbefore being authorized under any circumstance,t am the owner,or 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 Law48.27 RCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> PER 1T# <br /> 4 <br /> W <br /> OwneriAuthorized RgentSigna ure Date (Revised 51 0/2096) <br />