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PERMIT APPLICATION <br /> SUILD16/MECHANICAL I PLUMBING I SIOftPI�INKLER I DEMOLITiON <br /> CITY OF EVERETT PERMIT SERVI <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov i www.everettwa.goviperm its <br /> ffPROJECT <br /> i lll1g® / VADDRESS: �GC`) � t ' PROPERTYTAX#: <br /> =:Jonstruction: Short Plat/subdivision Lot No. (attach gopy of long legal description) <br /> OWNER NAME: GA-r'. f` TENANT NAME(If Commercial): S <br /> OWNER MAILING ADDRESS: STREET 3 -1 <br /> CiTY STATEY ZIP <br /> OWNER PHONE: 2 ' L`4" ' - �M y Y OWNER EMAiL: <br /> CONTRACTOR NAME: (�=t _� A6 <br /> CONTRACTOR ADDRESS: STREET 2 t 7_C- <br /> CITY <br /> CCITY tx� STATE WA zip Ci V-2X <br /> CONTRACTOR PHONE: (LtZ5) (4CONTRACTOR EMAIL: 1 ✓�C. L`7�5(r►7 t<��=C C71�J <br /> CONTRACTOR LICENSE#(REQUIRED): 1�VCCZC�`s ' . <-• CITY OF EVERETT BUSINESS LICENSE#(REQU[REII); <br /> PRIMARY CONTACT: 'CI OWNER CONTRACTOR VEl OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: i tS7 <br /> lz -(aZ CONTACT EMAIL: �� S%Yy �� � <br /> BUILDING,PERMMAPPL DATION <br /> Existing Use of Building: Contract Price of Work:$ `L <br /> Proposed Use of Building: UHeat Source: JQQas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi-Family-#of Units: Mommerciai ❑Industrial <br /> Type of Project: []New C(Addition /❑} Remodel (•Repair EIT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK; `j I` Lfs� 14tp`tl= i, T11 'k c G /2c L L' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> :..'6ltttdl�Ar4iC�,L OkkM1'if`e�PP.'R. 601 N PLUMBING . EIZi?/i T.A00JUdA1fid I <br /> Type of Project: _New_ Addn Alteration _,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 Units 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 Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan ISink(ServiceiBar/Mop/etc.) I Other: <br /> �Prf9& 1L1-R_/ Diialf � i®RI.�� It' ttl,.. <br /> Number of Heads <br /> ACKNOWLEDGEMEN '/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.lam the owner,or i am authorized by the owner of this property to perform the worlf for which application is made, <br /> and/comply with the State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> M I <br /> Owner/Authorized AjL&At Signature Date (Revised 5/20/2096) <br />