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PEF:�('►l�'A��I�ICA�"IOi� <br /> �3lJI[�Dli�i�i�CHA�IIC1�1/ P�l1�fl�li�G/ SI����I��C�.��/ D�flf�OLI�iON <br /> CITY OF EVERETT PERMIT SERVI <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)42b-257-8810 � FAX 425-257-8857 �(E)everetteps@evereffirra.gov� www.everettwa.gov/permits <br /> (����.���9�iei�.➢u��s�av�y�PD��s�) �L���G�'1�.�8'g'� 66�1.6��1�h��`�9�6�9 . <br /> PROJECT 51TE ADDRESS; Z �j ��• � ���}� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plaf/su6division Lof No. (aftach copy of Iong legai description) <br /> ... . _ _ . .. ; . �� _.. <br /> , .... .- .... . .. <br /> _ R9�i'�CSt'IIV���iViA'�'I�6d <br /> OWN�R�IAME_ � �/{ �,t � TENAPIT NAflIIE(If Commercial): <br /> OWNER MAILING ADDRESS: sTREer � •�� <br /> cirv srnTe �..�-: zi� �� _ <br /> OWNER PHONE; � - — . �' OWNER EMAfI.: <br /> _, ..:._... ....... _..._.. . _,. ... _. .,.. .. ... _ :_...,r. ..,... ,..�,.. �.... .. _.. . ......, .. _ .:...�...,. � ._. .. ... .... .. ........ .. <br /> CONTRACTOR NAME; �/ ' �'71�} � � � � (y <br /> CONTRACTOR ADDRESS: sTReET S � � <br /> � - <br /> CITY -� STATE ZIP � ��� <br /> CONTRACTOR PHONE: �—'3// CONTRACTOR EMAIL: ':q .�i''S�j�yJl��,, l r,� <br /> CONTRACTOR L[CENSE#(REQUIRED); ✓ I� � r'� � CITY OF EVERETT BUSINESS LICENSE#(REQUIRE�):L1�J'7 �j� <br /> PRIMARY CON7ACT: ❑ OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAM.E: CONTACT PHONE: � S ' _ - - � <br /> � ��� .- CONTACT EMAIL: '���iSS/�UJC(Jl� � <br /> . <br /> _ __ . <br /> ` _ . ; BUILDING PERMIT.APPLICATION <br /> Existing Use of Building: Confract Price of Work:$ /,rj. � <br /> Proposed Use of Building: Heat Source: as ❑Elecfric ❑Other <br /> Building Type: ❑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: � � -- �' �Q��/�ti;�rj C�([,� �piUr — 5iti�• <br /> ' S'Tyt-t..t_ K�3.e� Q'��v (p�� �.f'>��L'�. dG�/ � <br /> Gl�r T Gl��r✓I���z� ��-Gt —�'y5��L r ��5 �l!��� ) �,��rTdz'�Z.- �.v(✓!��.�i, �-�-. <br /> �L-��'-����-�--�t zzE,�;� j� �r r�v� ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,:. ... <br /> MECHANICArL PFftMiT APPLICATION ' PL�IMSIMG PERNii7':APPLICATIOId <br /> Type of Projecf: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alterafion _Repair <br /> #of List of Fixtures #of List of Fixfures #of Lisf of Fixtures #°� List of Fixtures <br /> Fixtures Fixtures Fixfures Fixtures <br /> Fl!C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heaier Bafhfub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Founfain <br /> Wafer Heater Refrigeration Shotiver Floor Drain <br /> Gas Fireplace Wood Sfove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clofhes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range I-]ood Water Heater Other: <br /> Exhaust Fan Sink(Service/BarlMop/etc.) Other: <br /> _ _ , .... <br /> �Pit➢t�lC�ILER./�lYl���iI�SSQO�01�Y�'Y`ENl <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�1/�ave reviewed this application and confinn the info�mafron contained herein is frue and conect. Work done pursuant to this permit must comply with <br /> currenf federal,state,and local law. The granfing of a pe�mit only authorizes approved v✓ork and no deviations therefrom.Deviations must first Ge autl�orized in v✓riting from the <br /> Building Official before being authorized under any circmnsfance.I am the owner,or!am aufhorized by the ov✓ne�of this property fo perform the work for which applicafion is made, <br /> and/comply wifh fhe State Contractors Law 98.27 RCW and 296200A WAC_ <br /> City of Everetf O�cial Use Only <br /> � PER <br /> �� � � /� <br /> Owner/ uthorized AgenE Signature Dafe (Revised 5/20/2016 <br />