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PERMIT APPLICATI�I
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<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 /> � `' ,� .�,:d+'`t��� . :� PROJECT���'�'E�Iid�O TIQ �;�;: � ` `� �' r�� ° '�
<br /> ��. �.. � ��. M�., f r�- �,�r� ��.��x,�., .-�� �k�
<br /> PROJECT�TaE� DRF�S: J��;F� � �`v�v „� PROPERTY TAX#: � ��� I ���� �,���;
<br /> i�
<br /> LEGAL for new construction: Short PlaUsubdivision_�c:y���'ll� i�'1�� Lot No. � (attach copy of long legal description)
<br /> . '.Y �"�; s; � a�V�NTAYT'`�NlVR�Rrl�1G� t �'i�r : � "�`�` �'a. i �''�,t' }
<br /> - t ..�?., � i. �t7 �'
<br /> OWNER NAME: �T�,j, . � � ,�,� TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: s-rReer p 2,`�'� �,� (_
<br /> . . CITY � `� ��v'� � STATE (� ZIP �� �
<br /> OWNER PHONE: 2 - ��, OWNER EMAIL: �,1 � . GO 0`�
<br /> _ _M. _. _. _� � �.� „__ _ __
<br /> CONTRACTOR NAME: � � � � " -�c�
<br /> CONTRACTOR ADDRESS: sTReeT � �p �-
<br /> CITY ��,�����,�,_ � STATE C,,,�� ZIP $��
<br /> CONTRACTOR PHONE: � Z� �-}�y Q� CONTRACTOR EMAIL: �,�-in �G, 'ic�Q G`„�
<br /> CONTRACTOR LICENSE#(REQUIRED): �G �0��{� �j� CITY OF EVERETT BUSWESS LICENSE#(REQUIRED): �����
<br /> PRIMARYCONTACT: flOWN��� ... _��.. � .�� _ v.�,� .v��._ �__�_,._�-_. . � ���, � ._,��, m�_�,.,N...� �.�- .�,_�o_�t����_ _._= r,� _r. .. ,. ,�w
<br /> ER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: e,���-. � �� -. �,'� � �
<br /> �`�a/\,ct'.�n �st��Y�g�j� CONTACT EMAIL: ����� ,��� r ���,�,�
<br /> � ,,� _ BUI�LDING;:PERMIT,APPLICA'�ION�" � ��:`'� �, ,
<br /> Existin Use of Buildin : Contract Price of Wo :$
<br /> Pro osed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other
<br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ❑Commercial �Industrial
<br /> T e of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:
<br /> �c,,.�.J�C�� CJ':�h �.s ^..'._°�'
<br /> ASSOCIATED BUILDING PERMIT# if a licable : � �aC� � 'd' �
<br /> , f. �MECF�EINICAL pERMIT;APPLICATION a'� s;�, tnr ,PI.UIIIIBI,1,!�G PERIVl1T A�PL.ICATIOM..A,.'= ,.._ ; P�. `;;;
<br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair
<br /> Fixtures ust of Fixtures Fixtu es usf of Fixtures Fixiures ust of Fixtures Fixtu es 1�si of Fixtures
<br /> A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bid )
<br /> Forced Air S stems ' Unit Heater Bathtub Urinal
<br /> Gas Pipin Boiler Lavato (Wash Basin) Drinkin Fountain
<br /> Water Heater Refri eration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Dis osal Grease Tra
<br /> Gas Ran e ' Ducting Dishwasher Roof Drains
<br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan Sink Service/Bar/Mo letc. Other:
<br /> ;SPRINI�LE,R,1 gt�PPRESS�ON;SYSTEM;, �
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with
<br /> current federal,state,and/ocal law.The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Officia/before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Cont actors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> AW`�` 1�-� �r I(�' J� PER �Q ` O �
<br /> 0
<br /> Owner! orized Agent Signature Date (Revised 10/12/2015)
<br /> �
<br /> a 0 • o �'S ���%�
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