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PE�9l6i9T'�a�PL�GAYiO� <br /> �@J9LDIN(� /i�i�CF9AiVLC�4L/ P�IJ II��1�� /�ICN /SP�IY��L..ER 1 �E�OL9�'10�9 <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 /> (�laae mr�lack InE��n8y�leas�� P��J��`�'SITE IId���I�iA�'1�i�9 <br /> PROJECT SITE ADDRESS: (� i j�� �'L:��� � �t8 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C0�+17'�C`�' IQdFORMA7'I��I <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srRe�r <br /> � ��Ty _ STATE � ZIP . <br /> OWNER PHOPVE: OWNER EMAIL: <br /> CONTRACTOR NAME: �'jj�(i( �if <br /> CONTRACTOR ADDRESS: s-rReET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAfL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED); <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Piease Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMA1L: <br /> �IIILDINE9 PERMIT APPLICA7'I�P9 <br /> Existing Use of Building: Contract Price ot Work:$ S <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commerciai ❑Industrial <br /> Type of Project: ❑New ClAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �,d.� 1 �oi I��� -� c� . b��j . <br /> ASSOCIATED BUILDING PERMIT#(if appiicable: <br /> MECHANICAL PERMIT/�PPLICATION PLUMBING PERMIT APPl.lCATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #of List of Fi�ctures #of Lisf of Fixtures <br /> Fixtures Fixtures Fixtures Fi�ctures <br /> A/C—Air Handling Units Hest Pump Toilet Backflow Preventer{inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups j Other: �pj� Ciothes Washer Medical Gas <br /> Range Hood Water Neater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRIMKL.ER/StJF�PRESSION aYSTE1Vl <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the information contained herein is true and correcf.Work done pursuant to this permit must comply with <br /> current federal,state,and/oca!/aw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by fhe owner of this properfy to perform the work for which application is made, <br /> and I comply with the State Contractors Law 98.27 RCW and 296.200A WFl C. <br /> City of Evereit Official Use Only <br /> i�r� /��'��� �-`��/�� PERMIT# <br /> O er/Authorize ge'nt Signature Date (Revised 9/23/2096) <br /> � ���c� - a c 3 <br />