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����s-�����oc�,-�ao� <br /> �U9L�9NC91 f�I�CHAY�ICA�./ �Q..9Jii��1V�G 1�iGiV/���9P�G��.ER/ ���OL.V�IOY� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everetfwa.gov� www.everettwa.gov/permits <br /> (�iee���-�lae9c 9��C�a�Ly�lease) ������'�'�9'�'E �NF��9Vi�fi'90� <br /> PROJECT SITE ADDRESS: � �.�� � �� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �ON7'�AC"�' OIV�'�RI�AA'�I�BU <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWiVER MAILWG ADDRESS: s-rae�- <br /> � CITY " . STATE � ZIP <br /> OWPIER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; '�jj�,�1�� <br /> CONTRACTOR ADDRESS: srReer <br /> CITY � STATE ZIP � � <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY COiVTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTAGT NAME: CONTACT PHONE: <br /> CONTACT EMAI�: <br /> BUILDIN(� PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: 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.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ��� , ��1 ���/ �-� � . �j . <br /> ��� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPl.ICATION <br /> Type of Project: _New_ Addn A(teration Repair Type of Project: _New Addn Aiteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #°f List of Fixfures #of List of Fixfares <br /> Fixfures Fixtures Fixfures Fixtures <br /> A!C—Air Handling Units Heat 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 Fioor 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�� Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> S�RIWFCL.EIt I SUPPI3ESSIOI�1 SYSTEM <br /> Chemical or Water No.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 local law.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.1 am the owner,or l am authorized by the owner of fhis properly to perform the work for which application is made, <br /> and I comply with the Sfate Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Evereft Offcial Use Only <br /> � <br /> %/ ` � � PE /ln � � <br /> � ���� �, � � <br /> � � <br /> O er/Authorize •�gent Signature Date (Revised 9/23/2016) <br /> ���o� "' �l lv <br />