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PERMIT APPLICATION
<br /> BUILDING I I�CHANICAL/ PLUMBING/SIGN / �INKLEF2/ DEMQLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everefiwa.gov� www.everettwa.gov/permits
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<br /> � _. ,- . PROJECT SITE:INFORMATION , ,., , , . ,`.':.'
<br /> I� JECT�� ITE ADD ES�; PROPERTY TAX#. �
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<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legai description)
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<br /> CONTACT INFORMATION
<br /> OWNER NAME: � � L�j��,} TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTReEr ���' S� 'T
<br /> CITY � STATE ZIP ���
<br /> OWNER PHONE: �Z��3J .�- d� OWNER EMAIL:
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<br /> CONTRACTOR NAME: D <I'I�/T`� �iC.I'�Ig
<br /> CONTRACTOR ADDRESS: srReer � �� / � � •
<br /> CITY ��J�Q� STATE ZIP��
<br /> CONTRACTOR PHONE: �Z j-'f'7�-� CONTRACTOR EMAIL: {��it(ftv��� ��y�1�'J� �� �
<br /> CONTRACTOR LICENSE#(REQUIRED):� (-}q' CITY OF EVERETT BUSINESS LICENSE#(REQUIRED). �� /�"�
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<br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: Lf--2cJ.--7�C��(��
<br /> ��z 'v�C�" ���''�'Y'� CONTAGT EMAIL: ����� � ���'�,
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<br /> :.. , �. ::. . : ; BUILDING PERM,IT APPLICATION. ` �, � -
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<br /> ��ing Use of Building: Contract Price of Work:$ o� ����
<br /> � osed Use of Building: Heat Source: ❑Gas �Electric ❑Other
<br /> Building Type: ❑SFR-Detached �S,FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodei ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ���,� ��Grn�� �.�- w,�hT�L..�A�lC W �" NP�� �L�7"�L{�
<br /> k�T GU�G 7-�vK T� ��rn.� L ac'Anon�.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> NIECHANICAL,PERMIT APPLICATION ; , `,:, ... , " PLUMBING PERNIIT APPLICATION.'`, ',
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair
<br /> #of Lisf of Fixtures #of Lisf of Fixtures #of List of Fixtures #°f List of Fixtures
<br /> Fixfures Fixtures Fixtures 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 Neater 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 Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/SUPPRESSION SYSTEM '
<br /> Number of Heads
<br /> ��^IOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permif must comply with
<br /> t 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 /> ng Offrcial before being authorized under any circumsfance.I am fhe owner,or!am authorized by the owner of this property to perform fhe work for which application is made,
<br /> and l compiy with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett O�cial Use Only
<br /> P RMI #
<br /> 1 �o �� C� C - 2
<br /> Own r Auth ized Agent Sig r Da e (Revised 1 D/92/2095)
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