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PERMIT APPLICATI04'1 <br /> ' BUILDI*J MECHANICAL 1 PLUMBING I SIGN4�4NKLER I ®EiillOLF110N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Rsa ®a [ ll �l _Duvl ._®eu><jj Pl[� s�� -. , lG ®�CCTI6TE llN1 <br /> PROJECT SITE ADDRESS: ( j VL U I.91 AUf✓ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat(subdivision Lot No. (attach dopy of long legal description) <br /> OWNER NAME- At�t j TEkANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 15-14 JAU4UiA 4 <br /> CITY E STATE ZIP <br /> OWNER PHONE: 6 g5 Q OWNER EMAIL: Km. 14fn t-&-000'rA5V. "et <br /> -77 <br /> CONTRACTOR NAME: E7C.=( - <br /> CONTRACTOR ADDRESS: STREET ?—L7—or,> C�— <br /> ctrr STATE WA, zip <br /> CONTRACTOR PHONE: `L�25 'L5'L- 3(t j-E- CONTRACTOR EMAIL: Cvi,®. ems(rrllu�r <br /> CONTRACTOR LICENSE#(REQUIRED): C—Vi5�(Z&t-, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): " <br /> PRIMARY CONTACT: O OWNER CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE. s� ._O"7 Z- <br /> CONTACT EMAIL: �� ��5%Y1CL1 •Gf���r� <br /> UIL®IMG-PERINI it APPLhGA'I ION <br /> S <br /> '•,_� .. _ <br /> Contract Price of Work: <br /> Existing Use of Building: -- <br /> -1 <br /> Proposed Use of Building: Heat Source: ❑Gas liklectric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached QDuplex ❑Multi-Family#of Units: ❑Commercial El Industrial <br /> Type of Project: ❑New @(Addition ❑Remodel ❑Repair .I. OSign []Sprinkler @Demolition []Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IV7 CF'1i�[d_IC ,1L: I RMI`lI`AP��IGA7`1®1�! PLUMBING I�ERFAIT l�>�>�>i Arrl®f:9 <br /> Type of Project: _New_ Addn Iteration _Repair Type of Project: ,New _Addn Alteration _Repair <br /> of List of.Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Unifs Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal GreaMl)raln <br /> Gas Range Ducting Dishwasher Roof <br /> Clothes Dryer Hookups Other: Clothes Washer Mediange Hood Wafer Heater OtheExhaust Fan Sink(Service/Bar/Mopletc.) Other <br /> SSIO 9.aPYPTP.iltl.. . <br /> Number of Heads <br /> ACKNOWLEDGEMENT/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 Official before being authorized under any circumstance.l am the owner,or 1 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 98.27 RCW and 296200A WAC <br /> / City of Everett Official Use Only <br /> PER T <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2096) <br />