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<br /> CI'I�Y Of` EVEREI f PL=RMIT SERVICES
<br /> 32.00 CFDAR Sl RFt._�I, FVEREi l,WA 987_0!
<br /> (P)425-257-8810 � FAX 425-257-II851 �(E)everettepsLeverettwa.gov� www.everettwa.gov/pennits
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<br /> (�lu� ov �lac6c In�C ��ly Pl�ase) �°ROJ�C'q' SI'P� BPdFOd�f1�ATlt)�
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<br /> PROJEC7 SITE ADDRESS: `�j'..��)� ��-`t��,�,t��I�Zc,'l � �� PROPERTY TAX#: (,.(C�4�C>(�, �t!�' �[`>'y :.
<br /> LEGAL for new construction: Short PlaVsubdivision _ Lot No._ (attach copy of long legal description)�� ,z_ � ,�L
<br /> Ys-,--C�PdT1�,C�' !PlFORIViA'fltJi�f
<br /> OWNER NAME: ���.'��; ����_�Jl�.:�( � ,�E_�_�,iT��'ENANT NAME(If Commerci I): �t rt� ;�pC k��-�;���1Llj�i tL'
<br /> OWNER MAILING ADDRESS: srREET I L�C, `r f��j.?'�� �l,l�_ �_� _ ,��_..:l .�.;�, _
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<br /> CITY „���"� ' - <..;� STATE "LIP � _/� ( ; .
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<br /> OWNER PHdNE: � 'z�y � r ; � � OWNER EMAIL: �.r.,,lr.J "> tl'i t�E. Y�C� --C:a l)l r��ti C Cr
<br /> CON'fRACfOR NAME: F's{�'�� •F�,C � C C'{';�`���uJ �C_ t 1�_•;�.�, �P-X_.-_ -- --
<br /> CONTRACTOR ADDRESS: srReer �G ' ��.d\v',���-��
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<br /> CONTRACTOR PFIONE: �� � r, �j�)e'7. f ` �(�[� CONTRACTOR EMAIL: )i.� '-.� (_�/ � t�. " < i_i..:' �r�� � i�_' '-("l:
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<br /> CONTRACTOR LICENSE#(REQUIRED): ,��/}�-�� "', !�,s` _ _1 CITY OF EVERETT BUSINESS LICENSE it(REQUIR D).
<br /> PRIMARY CONTACT: ❑dWNER CONTRAC70R ❑ OTI-IER(Please 5pecify)
<br /> CONTACT NAME: CONTACT PH�NE:� ,,� � )�� �
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<br /> `}�.,,-- �: 0� � .— . CONTACT EMAIL: � ;
<br /> BUILDIPIG PERMIT APPLICATION
<br /> Existing Use of Building: ��_� �� • �_� Contract Price of Work: $ • �
<br /> Proposed Use of Building: � - �' '� Heat Source: as ❑Electric ❑Other
<br /> Building Type: ❑5FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial
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<br /> Type of Project: ❑New ❑Addition ❑Remodel � epair T.I. ❑Sign ❑Sprinkler `.1 emolition ❑Ctiange of Use _
<br /> DESCRIPTION OF WORK: 1
<br /> ���.��C'�-�.`�tt �-��-+ ���Zlt�.r:"1 �J�L�'.'� �� •�) �L�Z��� ��.L'C,:�.�.�j
<br /> ��� _btitc•� ��� �� �_.X�`�i 1r.k'--. �._c"��:� (.�.���'c��.._ 1�r� �� ��Z",;L:i���J ,�;t
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable): ��l�� _ � .{t�,; ��;� [ � �tl't��1� ~ � �.�c�c�i,� - i�•„ �.`, t\C_�.,
<br /> MECHANICAL PERMIT APPLICATION PLUMBIPIG PERMIT APPL.ICATIOM
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration __Repair
<br /> �t of List o(Fixfures #of List Fixtures #of List of Fixtures #of List of Frxfures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units at Pun,p Toilet ackflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Reirigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer H ups Other: Clothes Washe Medical Gas
<br /> Range Hood Water Heat Other:
<br /> Exhaust Fa Sink(Se celBarlMop/etc.) Other:
<br /> SPR LER/SUPPRESSION SYSTEM
<br /> Chemical or Water No. of Heads
<br /> AC!<NOWLEDGEMENT:1 have reviewed this applicafion and confirm!he intorrnalion coniained herein is true and correcL Work done pursuant to fhis permit nwsf canply wifh
<br /> currenf Iederal,s�ate,and locai law. The granling of a pennit only authorizes apprnved work and no deviations therelram.Deviafiorts�i�ust/irsl he aedhorized in wriliny frorn 1he
<br /> Buildin,q O(ticial before being authorizec!under any circumslance. 1 am the owner,or 1 am aulhorized by!he owner of ffiis propeny fo per(onn the work for which application is made,
<br /> and 1 comply wifh fhc Sfafe Cailractors Law 1ft.27 RCW and 296.200A WAC.
<br /> ___ Ciry o/Everett Offrcial Use Only
<br /> �.--'" - � PE�#I l
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<br /> Owne/Authorized Agent Signature D te (Revised 9/23/2016) /
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