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� PERPl�II�AP�L@C,4TI0� <br /> �l1fLDl�l� / fViEGHANICA�/ P�LJfVi�l�lC� / SIGYV I �PRIi�YLER I DEf�iOLITIOi� <br /> CITY OF EVERETT PERMIT 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 <br /> Q�lue or �la�l� ank On[y �le�s�) �R�JECT SI�'E 9N���f111ATlOfa� <br /> PROJECT SITE ADDRESS: �t'✓'�' � i� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of long legal description) <br /> COWTI4C°T IFI�012MA'1'IOPd <br /> OWNER NAME: L t' p S,sf/-� TENANT NAME(If Commercial): �,� �; C—,r <br /> OWNER MAILING ADDRESS: sraFET (.) ,�j�`�)( ��C' <br /> CI"IY �C'�TTL` STATE l�/� ZIP y �� ` <br /> OWNER PHONE: Zb(�j ��. S � F��7� OWNER EMAIL: <br /> COIVTRACTOR NAME: � � _ � Q�, /-FFi¢ .vE �`/�r/� <br /> CONTRACTOR ADDRESS: srREEr � `' �� ,�j j ,11.�� <br /> CITY //!LY j�/)(� @ STATE �/Q' ZIP 7 �� <br /> CONTRACTOR PHONE: L/2 j ,y � 5 �/U Z�' CONTRACTOR EMAIL: �i�v�-�cJ/rt j-�� c�Ct>t.rees /- �✓F-`7� <br /> CONTRACTOR LICENSE#(REQUIRED): �I O Q_p S � Ac��'i-�. V`3 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Q y�Z��� <br /> PRIMARY CONTACT: ❑ OWNER ,0 C�ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: y L s— S 3v � '� �� <br /> ��uL� (.(�vf#!S t"�'-t' CONTACT EMAIL: A i <br /> /l,l�r-� � te�:M �l� E� Cd ta 'f'" �x1f' <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �;,-�„1��;r� ��C��zt� Contract Price of Work: $ C, � �(u�`i � <br /> Proposed Use of Building: � \ � ' Heat Source: ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1\ <br /> (1s" E7�T� h t2.e�'��cP lr.��nc;�v�.:r 6�-�'��� �C.� ... � <br /> i� 1�. vc-�'�P�S I��v+� �vw�� _ <br /> 1-�F�-rt- ,��-,�,-.p o Y, C�f��,,t�.. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLI�ATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> ��f List of Fixfures #�f List of Fixtures #�f List of Fixtures #°f List of Fixfures <br /> Fixtures Fixtures Fixtures Fixfures <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 /> SPRINKLEF2/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMEN�:I have reviewed this application and confirm the infonnation contained herein is true and correct. Work done pursuant to this permit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> 8uilding Official before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply witir the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> , � PE�T , � ��../ <br /> r0-2G-J �7 ti�, <br /> � �.,� v <br /> wner/A ori e gent Signature Date (Revised 9/23/2016) <br /> � � ��. <br /> �/ <br />