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• � <br /> PERMIT APPLICATtON <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S7REET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)�u�x�tkepS'�'�tt evetattwa,gca�� www.evererivra.govlpermits <br /> (E�tue or Black lnk Cinly Plea�e} PROJECT S1TE INFORMATION <br /> PROJECT SITE ADDRESS; � (� j"�$�'' L�(,,�''�,� PROPERTY TAX#: <br /> LEGAL for new constructfon: Short PlaUsubdivislon Lot No.` (attach copy of long legal di3scription) <br /> CON'TACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Gammercialj: <br /> OWNER MAILING ADDRESS: s�eer � }�(t <br /> C� 1.,�.\f STATE �"� ZIP �j 3�O l <br /> OWNER PHONE: y 2�j OWNER EMAIL: <br /> CQNTRACT(5R NAME; �Y3 L <br /> CUNTRAC'fOR ADDRESS: srReer ,� ��„�,,,,q,� <br /> C�N STATE �- 21P ( <br /> GOM1tTRACTOR PHONE: �,��, {`„� � CONTRACTOR EMAIL� (('� ,�[} <br /> C£�hl'fRAC7"Df�LIGEI�S�#(REQUIREt)}: ''�C. CITY d��YER�TT 8t1SiMESS I.ICEt�3E#(REQUINEO): {��p�'� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify} <br /> CONTACT NAME: �� CONTACT PHONE: t,.�,'Z•�J- 25� ���`�1 <br /> � `,,,, <br /> Gt1NTACT EMAIL, l.� �`UGta.+ �C.O <br /> ` BUILDIMG PERMIT APPLICATION <br /> Existin Use of Buildin : ContracE Price of Work:� � ���t� <br /> Prapased Use of Bulldin Heat Source: a8 ❑Electric ❑Other <br /> Buildin T e: SFR-Detached ❑SFR-Altached ❑bu !ex ❑Multi-Famil -#of Units: ❑Commercial Olndustrial <br /> 7 pe of Prc�Ject: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> R�l A2e, o�a,5 {�i.� r v�..a.ce, <br /> ASSOCIATED BUtLDING PERMIT# if a��plfcabfe): <br /> MECHANICAL PERMIT APPLICATION PLUMBING pERMITApPLlCATION <br /> Type of Project: _New _ Addn _Alteratlon Repalr Type of Project: New Addn __Alteratlon Repair <br /> #of #of — <br /> Flxtures List o/Flxtures Llst of Flxtures #o/ Llst of F/xtures #°� Llst of F(xtures <br /> Fixtures Ffxtures Fixtwes <br /> A/C-Air Handlin Units Heat Pump 7oilet sackfiow Preventer Inside Bld ) <br /> � Forced Air Systems Unit Heater Bathtub IUrinal <br /> Gas Piping Boiler Lauafary(Was(�8asiraJ Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Draln <br /> Gas Fireplace Wood Stove Kitchen�sink�t}is osal Grease Trap <br /> Gas Ran e Ducting Dishwasher I�oof Drains <br /> Clothes Dr er Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heafer Other: <br /> Exhaust Fan Sink SerVic�IB�rlMta /et�.j Other. � <br /> SPRINFfLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.1 have reviewed this applieafion and conliim fhe!n/ormallon conlained herein is lrue and conecl. Work done pursuant fo[his permif must compty wifh <br /> r,urranl tederal,stats,and Jocat taw. The�ranfing o!a psrm±t only authonzes approved woric and no davia(lons there/rom.Devialions must(irsf be authorized in writing lrom the <br /> 13wtcfing Official betor�betng au(honzed under any circumstance.1 am fhe owner,or 1 am authorized by the owner of fhis property to pe�fo�rn(he work lor which applicallon is made, <br /> and!comp/y with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE IT � <br /> � ib �2-� �i7 � l ^ <br /> Ow ertAuthorized Age Signaiure pat�, i��y������Qy�} <br />