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<br /> PERMIT APPLICATION
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERcTT PERMIT SERVIC�S
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 ((E)everetteps@everetri:�a.gov� �v��nv.evereth�,2.gov/permits
<br /> (Biue or Biack!nk Qnly Please) PROJECT S�'FE fi�FORMA't'ION
<br /> PROJECT SITE ADDRESS: � �-i G � � ��j- ��1"- �;,- PROPERTY TAX:�:,^ � �� j � ,��
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<br /> LEGAL fc r,ew c;�s;ruaicr S^or.P!aJsuCdivisice Lot No. (a:tach copy o;:crg legal desc�ip,ion)
<br /> G�NT�kGT t�d�S3RMd,Ti�ta
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<br /> OWNER NAME: 1���..�,�-j ,-J v+c�C;,�,�`i� TENANT NAME(if Commercial):
<br /> OWNER MAILWG ADDRESS: s��eer S 1-I `�y I,��- c��� Lt�
<br /> cir. L t/�v'�`r--F- sr- �i�/� zi= C��v?G.S
<br /> OWNER PHONE: L+�S- �5 -�j- -I 3�"f J OWNER EMAIL: /j/�/�
<br /> CONTRACTOR NAME: /v� fr1,A�T�;,�j�j{�� S , �L
<br /> CONTRACTOR ADDRESS: ss�e- j ??�,�� ( �-� �V-� ��
<br /> crv � 1 i t�� � s-,�r C.L'1'� z:� �'1�Z z�
<br /> GONTRACTOR PHONE: ���-y�� c:�j y 5 CONTRACTOR EMAIL: �j/�,�.{�j-(^����•S�' r:�,;,,-�'�,C�;�
<br /> CONTRACTOR LICENSE TM(r2EQUIRED):�/ui t?��f j�Q --S�y� CIN OF EVERETT BUSINESS LICENSE'�#{REQUIREDj: � � (?��
<br /> PRIMARY CONTACT: �OWNER �CONTRACTOR ❑OTHER(Please Speci"ry)
<br /> CONTACT NAME: CONTACT PHONE: �(�� . �5-3_ �---1 3 '�7�
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<br /> t 1C�d i:1 ;/ �Tch �i-�v'1`,�,� CONTACT EMAIL: ��-
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<br /> �UILDlNG PERMIT APPl.tGA'tiON
<br /> Existin Use of Buildir,o: Contract Price of Work:5 `���
<br /> Proposed Use of Building: Heat Source: BGas ❑Electric ❑Other
<br /> Buiidin Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family�#of Uni±s: ❑Commerciai ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel �Repair ❑T.I. ❑Sigr ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ��
<br /> id Lt�1�Z� 41���#-'�:'-.. I � �_s ��c -r ��:t�— �!�e�.+c: i..c.,.� �., r.
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<br /> ASSOCIATED BUILDING PERMIT:.(if applic�ble):
<br /> MECHANICAL PERMIT-APPLICAT[�At PlUMBtNG PERMIT APPLICATICIN �
<br /> Type of Project: _New _ Addn _Aiteration �_Repair Type of Project: _New Addn Alteration _Repair
<br /> ;�of List of Fixtures ��f #of
<br /> Fixtures Fixtures List of Fixtures Ff�ures Usr of Fixtures List of Fixtures
<br /> Fixtures
<br /> A!C-Air Handling Units Heat Pump Toilet Backf(ow Prevenfer(Inside Bidg;
<br /> Forced Air Systems Unit Heater Bathtub Urinai
<br /> G2s Piping Boiler Lavato
<br /> I Water Heater ry(Wash Basin) Drinking Founiain
<br /> Rerrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposa( Gr2ase Trap
<br /> Gas Ranga Ducting Dishwasher
<br /> Roof Drains
<br /> Clothes Dryer HooRups Other: Clothes Washer Medical Gas
<br /> Range Hcad Watar Heater Othzr:
<br /> Exhaust Fan Sink(Servica;Bar/Mop/etc.) Other:
<br /> SPRINKLER/SUPPRESSlON S1fSTEM
<br /> Chemical or W2ter No.oi H=ads
<br /> ACKNOWLEDGEIrcNT:1 have reiiE:�ey tnis appl;c2!,'cn and co.oiirm th.e rnfo;rnaticn con,ained narein is true artl CCrrecL V✓ork done pursuznt to thrs permit must comply�vdn
<br /> currern federal,s:a:e,ar,d loca!lav.t The graniing of a permA on/y autnorizes approve��vor'K and no deviations?heretrom.Daviations mus!first be authorized in wrdrng from tne
<br /> Burlding Glficial befor�being authaized under any circumstance.1 am tne o�me�,ot!am aw,hcnzed by th.e��me�of this p�operry to pe�form Ghe,vork for��h;ch applrcation is made,
<br /> and 1 comply:vi.'h tne Sta!e Con!2ctors Lav 18.27 RCVY antl 296.200A V/AC.
<br /> Crty of Evar2tt Oficial Use Only
<br /> ? PERMIT#�„ � � ��
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