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� PERiVIII'APPLIGATIO�
<br /> BUILDIN(�/ MECHAIVICA�/ PLUMBING / SIGIV / SPRINKLER/ DENIOLITION
<br /> CiTY OF EVERETT PERMI7 SERVICES
<br /> � 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> -: , ;�; '- " P;ROJEC'i' SITE lNFO:RMATION ' -
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<br /> PROJECT SI DD ESS• PROPERTY TAX#:
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<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> CONT.ACY 1�lFOEt�VV1�T10N ` ' '
<br /> OWNER NAME: 3�Z��(_;"' ,Ji�.l;�L � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: srREer � /� f�j j � S�i �
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<br /> CITY � '�r �� �� STATE l j� ZIP ���Ci C�
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<br /> OWNER PHONE: Z O(c� "UJ I ��I - 7 7 2 OWNER EMAIL: � • ' �,'1 % S ' ' '/1,1C:' � '
<br /> CONTRACTOR NAME; L.� l� ���' '=`.^; � '7 � �
<br /> CON7RACTOR ADDRESS: sTrtEEr (�,J /Ui z � ��` :S��_
<br /> cirr lA}C�U\�i� �✓'�'L�-i'� STATE " ziP u Q�l�
<br /> CONTRACTOR PHONE: ��,�7 ci U � LJ` � -'r� -'r� CONTRACTOR EMAIL: I'�i�V�T����D C/�' ��'��/1 '�}� ^-'�'-'
<br /> CONTRACTOR LICENSE#(REQUIRED): CL L.y�►`� �-L `l � 'J� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
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<br /> PRiMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �:V � !�!)L „-�j/5�
<br /> C�IZ.\i�.4,� ����%����,�j CONTACT EMAIL: ,�,�1/�/U.� ^. �e � ��:.-,/U,' _`/
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<br /> ` ,:: ,BUILDING;.PERMIT AP.PLICATION ::
<br /> Existing Use of Building: ,� �,� i� " � Contract Price of Work:$
<br /> �� ,.�,�,. ,.=g;.,,.,;��: Heat Source� ❑Gas ❑Electric ❑Other ____ _________
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<br /> Buiiding Type: VC�SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: s �.
<br /> (/Q.���v� "�/-F�i;UG i-/ �C'%��i r�,�-�'--%.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> 'IVIECHANIC.AL PERMIT APPLICATION;:
<br /> ;.: PLUIVIBING PERIVIIT AP;PLICA710N_"-:
<br /> Type of Project: ,_New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> �of #of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> q/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg}
<br /> Forced Air Systems Unit Heater Bafhtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Wafer Heater Refrigeration Shower Flopr 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 /> ' SPRINKLER I,iSUPRRESS. ION SY'STEM _
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<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•1 have reviewed this application and con(irm the information contained herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,sfate,and Iocallaw. The granting of a permif only authorizes approved work and no deviations theref�om.Deviations must first be authorized in wrrting from the
<br /> Building O(ficial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of fhis property to perform the work for which application is made,
<br /> and I comply with the State Contracfors Law 98.27 RCW and 296.2ooA WAC.
<br /> ,,/� ,_ City of Everetf Official Use Only
<br /> �-"" �'� PERMIT# ��
<br /> .�- .� � ,��'j�{' �+ ) J�j
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<br /> O r/Aut orized Agent tur Date (Revised 10/92/2095)
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