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F'ERiI(11�'APPLICA�'IOf�
<br /> BUILDING/ f�f1ECFiA�IlC,4L/ PLUIli11BING I 51GN 1 SPRIY�KL�R/ DEi�IOLIT't0�1
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98207
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (�lue or�iac�lnl�Onl d� e _e) .:.. `�atOJ�G'Y'_SI�� 9R9F��fViP�'R"H�Rt:
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<br /> PROJECT S]TE A D E : ;�%�j ' J ��,.. � � pROPERTY TAX#:
<br /> LEGAL for new construction Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> . coe�v�c�r..a��orann�aa�p�o�a: ,
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<br /> OWNER NAME: � ,� , � � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: s-rReer
<br /> C17Y STATE ZIP
<br /> OWNER PHOIVE; OWNER EMAIL:
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<br /> CONTRACTOR NAME: ,�
<br /> CONTRACTOR ADDRESS: s-rR d. _
<br /> C� STATE ZIP
<br /> CONTRACTOR PHONE: L � !— CONTRACTOR EMAIL: ' �s . ��,� r (` ;t� r �
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<br /> CONTRACTOR LICENSE#(REQUIRED): �-��/'/��U G,/� � -� CITY OF EVERETT BUSI SS LICE E#(REQUIRED): ` �� ,� �
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<br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �i�� �3 •_ 7 �
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<br /> -�( �3.-, � ��, CONTACT EMAIL:
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<br /> � . ` �BUILDING PERMIT APPLICATION. . ._
<br /> Exisfin Use of Buifdin ��—
<br /> 9 9� Contract Price of Work:$ e
<br /> Proposed Use of Buiiding: Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Mu]ti-Family-#of Units: ..�Commercial ❑Industrial
<br /> Type of Project: CINew �Addition ❑Remodel ❑Repair C7T.1. ❑Sign ❑Sprinkler Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOClATED BUILDING PERMIT#(if applicable):
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<br /> MECHANICAL PERMIT/a1PPLIC.AT10Rl. ., .:,",. ` : . PLUMBIIdG PERMIT,APPLI;CA.TION;. . ;.
<br /> Type of Project: _New Addn _Aiteration _Repair Type of Project: _New Addn _Alteration _Repair
<br /> Fixtures U�of Fixtures Fixtures List of Fixtures #°f List of Fixtures #of Lfsf of Fixtures
<br /> Fixfures Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilet Backffow Preventer()nside Bldg)
<br /> Forced Air Sysfems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavafory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigerafion Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> C(ofhes Dryer Hookups Other: Clofhes Washer Medical Gas
<br /> Range Hood Water Heater Ofher:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
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<br /> ..���96�1��1�9i(;�L�A��9zL�����19�].SYS'�'1�M` .
<br /> Number of Heads
<br /> ACfWOWLEDGEMENT.�l have reviewed this application and confirm the information contained herein rs true and correct. Wo�k done pursuanf to this permit must compiy with
<br /> current federal,state,and/ocal/aw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must frrsf be aufhorized in writing from the
<br /> Building Official before being authorized under any circumstance.1 am the owner,or l am authorized by fhe owner of tl�is properry to perform the work for which application is made,
<br /> and/comply wifh the State Contractors Law 98.27 RCW and 296.200A WAC.
<br /> City of Evereif Official Use On/y
<br /> PERMIT#
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<br /> O:w, nep Authori Agenf Sign t e Date (Revised 5/20/2016)
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