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� P�RMIT'APPLIG�471Ot� <br /> �IJILDING/MECFiAfVICAL I V�LU�Il1�1�l� I�IGN/�P�IN�CL�R/ DE�fIOLIYiON <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� y�ww.everethva.gov/permits <br /> (�lue or Black Ink On1y Please) PR�.JE�'P SITE IRI�'�RM/�'TI�A1 <br /> PROJECT SITE ADDRESS: ��L'I �G''' PROPERTY TAX#: �,(�C' ��� ,ZL%Z4"'Cry�'J�'L� <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> CONTAGT INFORMA'f'IOPI <br /> OWNER NAME: �(,�(y-(��5�1 �N`F� i�( �-�-t TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREer f( / I� _5�'~{t`�1� <br /> arr �t�'-�T/Zi� srnrE i,�-�F� ziP ��-���� <br /> OWNER PHONE: %E'4'_4>S�. �,�l4"5� C�':ir' /i`G�t OWNER EMAIL: � ���C✓/�lc"�T�� �`��C .C.�-w� <br /> __..._. _ _ _..... _......__ .__..,.._. . _.`...L.. ._....... . . ..__.__. .. _._..._._ .._..,.. ..._._ . .._ . _ .... _,_.. ,. .. _ ...,..__.. .._..... .... ... . .: ........ ...... _. . <br /> CONTRACTOR NAME: C U�.�(�-�,� ST�TL� �j{�EE�{�1�(,GTA�CJ <br /> CONTRACTOR ADDRESS: sTREEr 2I`Lb A��� 14c(J(� <br /> CITY !:�UGyL�7 STATE �(,/�- "LIP ��� _ <br /> CONTRACTORPHONE: �-t'25-'�S2'�jII CONTRACTOREMAIL: MAVI���'4..tiywlw'4 -��a-` <br /> CONTRACTOR LICENSE#(REQUIRED): �(�t�`n.(fSS o22v CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)• C�b s' <br /> PRIMARY CONTACT: ❑ OWNER I�.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: l.f 2�_�S�_���Cd <br /> /��V�,�. , � yv�: CONTACT EMAIL: �p3i, , ���- r� . , •-� <br /> BUILDING PERMIT APPLICATION <br /> Contract Price of Work:$ J ° � � <br /> Existing Use of Building: ' �' ? ��`L�' � �•y �•� � <br /> Proposed Use of Quilding: EyC' Lf��G>� Heat Source: ❑Gas Electric ❑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 ❑Demolifion ❑Change of Use <br /> DESCRIPTION OF WOnRK: , <br /> ��L�LLt� � �� xt'� ,1��a ` ,{l� �� E'v tl.� �- �� `(1Lr '7� c %�(�5`�a c, ��Gt �� y� <br /> ! i i ' �Lr 1' �� l�(i � 1 2�,' � :7f � " �' f''C �Z- �L l, L•" y4 r-,� �iCL:.,;.�:��„� <br /> l� �'��-i+kL� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLIJM�IMG PERMIT APPLICATMON <br /> Type of Projecf: _New_ Addn _Alferation ILRepair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures ��f List of Fixfures #�f List of Fixtures ��°f List of Fixtures <br /> Fiatures Fixfures Fixtures Fi�cfures <br /> A/C-Air Handling Units Heat Pump Toilef Backflow Preventer(Inside Bldg) <br /> Forced Air Sysfems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavaiory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kifchen 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 I=an Sink(Service/Bar/Mop/etc.) Other: <br /> S�RIIV��I�R/S�1PIP�RI����BF7 �S�SYf�fL� <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the information contained herein is true and correct. Worlt done pursuant to this permit rnust canply with <br /> cur�ent federal,state,and local law. The granting of a permif only aufhorizes approved work and no deviations therefrom.Deviations must first be aufhorized in wri(ing from the <br /> Building Officia!before beiny authorized[mder any circumstance.I am the owner,or I am authorized by fhe owner of this properly to perfonn the wod<for which applicafion is made, <br /> and I comply with fhe Sfafe Cont�actors Lav✓98.27 RCW and 296.200A WAC. <br /> Cify of Everetf Official Use Only <br /> � PERM T# <br /> � �... � j��o/l � � " �� � <br /> Owner/Authorizea ent Signature —�Date (Revised 5/20/2096) <br /> � 7 <br />