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• PERMIT APPLICATION • <br /> BUILDtNG / MECHANfCAL/ PLUMBING ! SIGN / SPRINKLER / DEMOLITION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 982Q1 <br /> (P}425-257-8810 f FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everektwa.govipermlts <br /> (Blu,e or Biack Ink+C�nly �'I�a�e} R�QJE�7''.�T�1'�"E 11�PC'i�MA'f1Ci�t <br /> PRc3JECT 51TE ADDRESS: � �j p(,�,, �� PROPERTY TAX#: <br /> L�CaAL for new canstruction: Short Plat/subdivislon _Lot No. (attach copy of long legal description) <br /> �t�r��rac�r��For�MaYtar� <br /> OWNER NAME: Q,nQi`i- TENANT NAME(if Cc�mr»�rctalj; <br /> OWNER MAILING ADDRESS: srReEr � � �,� <br /> CI?Y �„�"�'�� STF�TE W'rl 71P `��,(3��kJ � <br /> OWNER PHONE: ,�, '�'� 2,S� b S� QWN�R EMAIL: <br /> CONTRACTOR NAME �—t�"'����-- <br /> CONTRACTOR ADDRE5S: sTReeT �`� (Z <br /> [;� STATE .,/'S ZIP ��„�,.+1 <br /> CONYRACTQR PHONE: � (� CONTRACTOR EMAIL: {�����, � G{/�+'[�.�(�l„'{'j�1.� . (,�4.y� <br /> CONTRACTOR LICENSE tt(REt�UIR��t; �'(Y'�h�l�"Y'�,Irt�'"j"td{'� ��7'y OF EVERETT BUSINESS LICENSE#(REQUIRED�: ��p�(� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) _ <br /> ..__. <br /> CONTACT NAME: • GC?IVTA6T RHOFJE: p� a59 �J'd <br /> �Y/L!f�� CC}NT'RCT�MAIL: d��l 'Q. ('�Y�uM'n '�0 M <br /> Bt�tll,�f1�#3 p�R�VIIT AP#�1�)P�`I'ICtN <br /> �xistis� Use of Biiiirlir� ; Gontract Price of Work.S :J�t�.i .(iC' <br /> Prc�posecf Use of Buildin : hieat 5ource: ❑Gas ectrlc ❑Other <br /> Buildir� T q��: SFR-Detached ❑SFR-Attached ❑Du lex ❑Mu(ti-F�mil -#of Un{ts; ❑Commerclaf ❑Industrial <br /> Ty��of Pro'�ct� ❑New ❑Addition ❑Remodel ❑Rt�pair ❑T.I. C75i n L Spr3nkler ❑Demolition ❑Chen r�of Use <br /> LlEBCRIPTION OF WOF2K; ��s� � ^�^ c S !-^ � � �w`� <br /> �-/1�-� VUt_V`. <br /> AS50�tATED BUILDING PERMIT#{ft�Gplicable'; <br /> MLCHA1+11CAL l�ERMIT,ApPt.tCATIC3� PLUMB�Nt3 P'ER�IRiT APPLI+CAt��1F1 <br /> Type of Project: _New _ Addn Alteratlon _Repalr Type of Project: _New Addn Alteratlon Repair <br /> #of Llst of Flxlures #of <br /> Fixtures Fixtures Lfst of Flxtures F/xfu es ��st of Fixtures Flxtu es Llst o/Flxtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air Systems Unit Heater Bathtub Urina! <br /> Gas Piping Boiler L�v�ic5 �Wash 8esinj Drinking Fountain <br /> Water tieater Refri eration 5hower Floor Drain <br /> Gas Firepiace Wood Stove Kitchsn 5ink&Disposaf Grease Trap <br /> Gas Ran e Ductin pishwasher Roof Dralns <br /> Ciothes Dryer Haokups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other. <br /> Exhaust Fan Sink(ServicelBar/Mop/etc. Other: <br /> SPRINl�CL�R 1 SUPAFtE�*.510N SYS"t`EI'VI <br /> Chemical or Water No,af Heads <br /> ACKNOWLEDGEMENT:!have rev/swed this applicatio�snd confirm(he ln/ormelion contained herein is We end conect.4Vt��k done pu�suan!ro�hrs permi�musf coniply with <br /> currenr tr.derat,slate,3ni4 facal tsw. 7he c�r�+Ntng o/e perrnrC only authorizes approved work and no devla(ions Ihere/rom.Devlailons must I7rs1 ba aulhorized in wriling trom fne <br /> 8url�ling C7fflcinl GR(a��b�irry ac�lht�rf�ni9�Jnder any cirr.i�rrtslrtnce.t am the owner.or I am autl�or/zed by the owner of fhis property to perform fhe work lor wh/ch applicalion is made, <br /> and!comply with!he S�atu Confraclors Law 18.27 RCVJ and 296.ZOOA WAC. <br /> City of Everett Gliicia!Use GnItF <br /> jj y/ ., r f # <br /> . —__-���"�__���__�! h,� �0°��!2.._.`,,,.DatP � Re i�r ��)� <br /> �{�Jlf-� ! <br /> Own�t l�tufirorixed A en i nature ( sed 9/�'3l2O f fi) � � <br />