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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 �(E)eueretteps(c��veraltwa.gpv� www.�v�r��v�.�c�vl{�eri°nil� <br /> (Biue or Black!nk anly�Iems�j PROJECT SITE`tNFC►RMA't'It�N <br /> PR�JECT SITE AQDRESS: 1-�(�'7 7 '�jT �G PROPERTY TAX#: <br /> LEGAL For new construction: Short PlaUsubdivisfon Lot No.� (attach copy of long legal descriptlon) <br /> Cf3NTAC'T INFORMATION <br /> �OWNER NAME; �Sh�l Is��r TENANT NAME(if Commercial}: <br /> __ _..... <br /> pWNER MAILING ADDRESS; s�eer �,,?�„„,� �' �� <br /> crrv �/�('� srnre ��} ziP a L.0� <br /> OWNER PHONE: �'j OWNER EMAIL: <br /> CONTRACTOR NAME; � y�L <br /> CON7RACTORADDRESS: sTREeT �� Q,(',,�,(�,(,� <br /> �� STATE "�- ZIP I <br /> CONTRACTOR PHONE: �q, {`� . C� �fJNTRAGTOft EMAIL• (� .GC� <br /> CQNTRAGT()R LICEN$6#{REtli11F�ED7: � R CITY QF�`VER�'t'1'Ett1S1N�$S i.ICENSE#(REQUIREC}}� ��O�$ <br /> PRIMARY CONTACT: ❑OWNER C(�NTRACTflR O OTHER(Please 5pe�ify) <br /> CC�NTACT NAM��� GONTACT PHONE: ��GJ �-�—JC� ��� <br /> CONTAG7"EMAIL: � ��� ,� <br /> BllILD1NG PERMtT APPLICATiON ' <br /> �xiskirs Use of Buildin : Contract Prlce of Work:$ ��.O� <br /> Propased Use of Buildin : Heat 5ource: ❑Gas lectric ❑Other <br /> Bulldin Type: FR-Deta�:her1 ❑SFR-Attached ❑Duplex ❑Muftl-Famii -#of Un(ts: ❑Commercial ❑Industnal <br /> Ty e of Projeci: ONew ❑Addition ❑Remodei ❑Re air ❑T.I. ❑Si n ❑S rinkler ❑Demolition C�Chan e of Use <br /> DESCRIPTION OF Wt�RK; ��cJ.l.�,II ��/1 IG�J /�� ��� <br /> l� <br /> AS50CIA7ED BUILDING PERMIT# if� plicabl�}: <br /> MECHANI+GLiL PERMIT APPLIGATION PLUMBING P�RM1T t�PPLiCATION <br /> Typa of ProJect: _New Addn Aiteratlon _Repalr Type of ProJect: _New Addn _Alteratlon _Repair <br /> #of <br /> 41�t vt�€l�cl�tras #of Ltrt;wf flxtu++aa€ #of �;tae#at t?i�aturaa #ot: _Ei�of Ffzttrres <br /> �lztvres FPxfures 1=Fxtures Flxtures <br /> A!C—Air Handlinq Units Heat Pum�a ,Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Svstems Uni#H��t�r Bathtub Urinal <br /> Gas Piping �piler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater R�:fri eratian Shower Floor Drain <br /> Gas Fireplace Waod Stove Kitchen Sink&E}is asal Grease Trap <br /> Gas Range Ducting Dishwasher Roofibrains <br /> Clothes Dryer Hookups Other. Ciothes Washer Medicai Gas <br /> Range Hood Wafer Heater Other: <br /> Exha�st Fan Sink{ServlGelB�arlMo latc.: Other: <br /> Sf'tiINKLER!SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> fiiCKNOWLEDGEMENT:t have reviewed thrs appllcafion and confirm the lnforma(ion contained herein 7s true and conecL Work done pursuant to this permif musi comply with <br /> currenf tederal,slato,and locallaw.The granting of a permi!only authoAzes approved work and no deviaflons fheref�om.Oevlaflons mus!8rst be aufhorized rn wnting/rorn fhe <br /> Building Offlcial before being authorized under any circumstance.t am fha owner,oi f am authoNzed by the owner of thls properly to porform ihe work for which appfication is made, <br /> and t comply with the Stafe Contractors Law 18.27 RCW and 296.200A WAC. <br /> Gity of Everett O�cial Use�nly <br /> � tl�r3•! P�# � "-' �� �� <br /> Qw erlAutharized Age 3ignature Date (Revtsed B/23f7096) <br />