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• • <br /> PERII!llll"APPLIC,4TION <br /> BUILDIfVG / MECHANICAL/ PLUM�ING /SIGN /SPRIfVKLER/ DEIi/lOL11'ION <br /> CITY OF�VCRETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-F3857 �(E)everetteps@everettwa.gov� wv�v.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PItOJECT SITE INFOItMAT10P1 <br /> PROJECT SITE ADDRESS: Z�3�� ��Cll[ �U� PROPERTY TAX#: (�(' �j S <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: � ��� �'7 TENANT NAME(If Commercial): E��j��1�(�j <br /> OWNER MAILING ADDRESS: sTREEr �,�i <br /> cirv �l��rL� s rn� ziP � 6 <br /> OWNER PHONE: ��i�- �('� OWNER EMAIL: <br /> __ _. _ _.._ _ . _ . __ _ ___ _ _ . _ _ _ . _. ___ _ <br /> CONTRACTOR NAME: C v��G�-�,{��! STlL1T(G� l7f�EE7{�1�(,6TR-cr <br /> CONTRACTOR ADDRESS: srREer ZI�LO ALl� �U(� <br /> CITY c U�� STATE �(/� ZIP (��ZO <br /> CONTRACTOR PHONE: 2S-�L �Z��j�I CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ��J��YL(ySS 0220 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): U b <br /> _ _ _ __.... . _ _. _ _ ... _. _._. _. _ _ __ __ .. _ _ . __ <br /> PRIMARY CONTACT: ❑OWNER I�.CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: C{2�'"_2S2_-�j��C/ <br /> M��j,� � CONTACT EMAIL: N''If''C�vl�- � S ►►��.11.A O� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: LGE � � � Contract Price of Work:$ �2 i ��� <br /> Proposed Use of Building: p�GCFT `? /�Gb'� �/�v C�FG� Heat Source: [�as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel l�Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> C��R !��(.� �dL L�l�, S�e �o�a�o,�, ��,�-cc,`�, S t�-� ����c-� 6�Tv <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration �Repair Type of Project: _New _Addn _Aiteration _Repair <br /> #of List of Fixtures #�f List of Fi�ctures #�f List of Fixtures #°f List of Fixfures <br /> Fi�ctures Fixfures 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 Sink(Service/Bar/Mop/etc.) Other: <br /> SPRIIVF�ZL�R/�iJPPR���i�P➢ ��(�`�I�tIM <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 rnust comply with <br /> currenf federal, sfate,and local law. The granting of a permit only autl�orizes approved work and no deviations fl�ei�efrom.Deviations must first be authorized rn wrifing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am aufhorized by the owner of this properfy fo pedorm the work for v✓hich application is made, <br /> and l compty wifh the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Oi�ly <br /> �� PERMIT# � � � �' �^� <br /> OwnedAuthorized ignature I I I�Date (Revised 5 0/7.096) ` <br /> `�� <br />