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� • i <br /> i <br /> ! <br /> � <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUNIBWG I SIGN / SPRINKLER I DEMOLITiON i <br /> � <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 GEDAR S7REET,EVERETT,WA 98'201 <br /> {P)425-257-nn10 � FAX 425-257-f3857 �(E)everetteps@everellwa.yov� tw�w.everellwa.gov/permits � <br /> (�lue or Black Ink OnlyP[ease) - PROJEC7 SIYE:IMFORMA71Uid -; '. � ; <br /> PROJECT SITE ADDRESS: ���/� (M �v I� v� PROPER7Y TAX#: Z.c�OJ'�Z.�C���-E�C��y�>C� E ' <br /> LEGAL for new wnstruction: Shorl PlaUsubdivision Lot No. (altach copy of lon�legal desr.ripfion) M � <br /> f <br /> CONTACT IMFORMA'TIQId - f ' <br /> 3 I <br /> _ t <br /> OWNER NAME s�cc_ �� � �y P TENANT NAME(If Commercial): S-L-'Cf-�GL' L �� � � <br /> OWNER MAILING ADDRESS: srREFr ��� I�j���( ��C,�I � 4 <br /> cnv r V.��-�� srnle 1..,%C�-l_ zir� rf'�S:! C' E + <br /> ; <br /> OWNER PHONE: OWNER EMAIL: � <br /> E <br /> CONTRACTOR NAIVIE: S H��-TIv1 � � <br /> CONTRACTOR AD�RESS:_ sTaeer��0� �Jp�/'.�'� � <br /> — — i ; <br /> cm ,e ,g, srn1E � zia Q � i <br /> I. t <br /> CONTRAC70R PHONE: Z.g=�O – �O CONTRACTOR EMAIL: �`{'(��� G'SH `t'r .0 pl•t�j ; � <br /> CONTRACTOR LICENSE#(REqUIftED): �` �( CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � � � <br /> E <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) ? <br /> CONTACT NAME: CONTAC7 PHONE: �� '3� e.-��'�� " � <br /> �`' � � �.}.� �" CONTAC7 EMAIL: ; � <br /> V C°�✓�J�LCG✓1 1 � �d6�t�.tdi+-f�a`S Z' V! , C e� � � <br /> BUILDINC PERMIT APPLICATION. � � <br /> Existing Use of Bullding: Contract Price of Work:$ S 2�O`�� ' <br /> � � <br /> Proposed Use of Building: Heat Source: �as ❑Electric ❑Other � � <br /> � r, <br /> Building Type; ❑SFR-Detached ❑SFR-Atlached ❑Duplex ❑Muiti-Famlly-##of Units: (�Commercial ❑Industrial j <br /> 7ype of Project: ❑New ❑Addition ❑Remodel ❑Repalr ❑T.I. ❑Slgn ❑Sprinkler ❑Demolitlon ❑Change of Use I; � <br /> DESCRIPTION OF WORK: <br /> �i�.�G�r�!�� �'� ��v�;r�c� �✓i'��- r �l r;� r r�/ �� r+���� C�v� t� � � <br /> f.� i <br /> i <br /> ASSOCIATED BUILDING PERMIT# if a Ilcable; � <br /> MEGNANICAL PERMIT APPLICATION PI.UMBING PERMIT APPLICATION . g � <br /> 6 r <br /> Type of Project; _New _ Addn _Alleratlon _Repalr 1'ype of ProJect: _New _Addn _Alteration _Repair � � <br /> #of #of #of #of � � <br /> Flxfures List of Fixtures Flxtures �-�st of Flx(ures Fixtures List of Fixtures Fixtures �-�st of Fl�ures '„ <br /> fVC–Air Handling Units Heat Pump Toilot E3ackflow Preventer(Inside Bidg) � ' <br /> Forced Alr S stems Unit Heater Bathtub Urinal - <br /> Gas Piping Boiler Lavato (Wash Basin) Drinking Fountain � <br /> Water Heater Refrigeration Shower Floor Drain P <br /> Gas Firepiace Wood Stove Kitchen Sink&Disposal Grease Trap € <br /> Gas Range pucting Dishwasher Roaf Drains e <br /> Clothes Dryer Hookups Other Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Olher: � <br /> SPRINKL�R/SUPPRESSION SYSTEM ' ` <br /> Chemical or Water No.vi Heads � <br /> ACIWOWLEDGEMENT.�1 have reviewed this application and confirm Ihe Informallon conlained herein is true and correcL Work done pursuant(o lhls pennit must comply with y <br /> cur�enf Iederal,sfafe,and local law.The granling of a permif only aulhorizes approved work and no devlafions therelrom.Devlaf(ons must lirsl be au(horized in wrifinc�lrom the <br /> Quilding Ofirclal trefore befng�uthorized under any circumstance.I am Ure owner,or I am aulho�ized 6y Ihe owner ol fhis property lo perform the woik(or which applicalion is made, <br /> and 1 comp(y wllh the S�at�Conlractors C.aw 18.27 RCW.and 2�6.'l.00Fl WAC. " <br /> City oI Everett 0Iliclal Use Only � <br /> , '_ _} �,,,�� , ,• __ l f'ERMI7# �/ y� <br /> � � �� ��y� �'<�.._ � '� _ 7� %��� �� ��� ✓ �V ��� <br /> .'� �� � r <br /> ,�OvJner/Autfiorized Agent Slgnature Date (Revisr.d�J/23/20?6) � <br /> �" ,% f <br /> � ]: <br /> `� ,l r 1 <br /> C I; <br />