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����!'d��f'.�f��fL8CA�906� <br /> f��9��.��6�C� / Y��C�6�aNICA�./ f��.���9�1� /��C��9 /��6��i��a�.�C�/��Y�H0�,9�°IO� <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 /> Q�loa��� �I�ck �ua�a�e�G��6���e� ����A��`�'�9�'� E����IVi�°�'s�� <br /> PROJECT SITE ADDRESS: $f ^..,...c� pBc�J PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �OI�`�'�C�' IN�'ORti��7'&OId <br /> sQ' OWNER NAME; TEIVANT PVAME(If Commercial): � /�,,,`w <br /> OWNER MAILING ADDRESS: sTREer � �j' ju .f � � <br /> CITY ' STATE �r� ZIP <br /> OWNER PHOiVE: �� � �j OWIVER EMAIL: <br /> �, CONTRACTOR NAME:L ii.-t�.� r /��vr�.,,s,},, G, <br /> CONTRACTOR ADDRESS: sTReer /Ze/ vn: <br /> cirr S h.,�-,.�s�. STATE w� ziP `I'�z}r� <br /> CONTRACTOR PHONE: L��%-� CONTRACTOR EMAIL: '�'��JiM,t�tf�f�/�""S�H "^tSc.��s�,cvr�. <br /> CONTRACTOR LICENSE#(REQUIRED):��/yr r� S 36 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED. <br /> PRIMARY CONTACT: �:OWNER ❑CONTRACTOR ❑OTHER(Please Specify) ` <br /> CONTACT NAME: CONTACT PHONE: �j/Z f' O-Z � <br /> !�l�.-i�� L�1 fZ�� CONTACT EMAIL•�%s�,.i�C�J.;,,,f.�irt j��,,5 4.-1 �/•�,'•� <br /> BUILDING PERMIT APPLICATtON <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Atfached ❑Dupiex ❑Multi-Family�of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ��// CIe�.N�.v� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IVIECFIANICAL PEltMI'�APPI.ICATION PtUM�ING PERMIT/�1PPL9��TION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn _Aiteration _Repair <br /> #of List of Fixtures #�f List of Fixfures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixfures Fixtures Frxtures <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 Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical G s <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SP9ZItd6CLE9Z/StJP�ItE���09d SYS7'�IVI <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 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 firsf be authorized in writing from the <br /> Building Otficial before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perForm the work for which appiication is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Only <br /> PERMIT# ��f ` �� `/� <br /> ...�..� , ��-/��/� U � � <br /> uthorized Agent Signature Date (Revised 9/23/2016) <br />