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��,t'�t� �?�� � � <br /> PERMIT APPLICATI� <br /> BUtLDiNG/MECHANICAL!PLUMBfNG/SfGN/SPRENKLER/DEMOLITION <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.everettvva.gov/permits <br /> (Biue ar Slack tnk Qnly Please} ; PROJECT SITE'IN�ORM/KTtON� <br /> PROdECT STT'E ADDRESS:rG3� r���.s�� .:��-,��,�; ?.t�� PROPERTY 1'AX#:��� �j j' �.p <br /> I.EGAL for new consUuction. Short PlaUsubdrvision Lot lVo. (attach copy of long tegai description} <br /> co�rrac��N�o��aTro�r ' <br /> OWNER NAME: ern (�� �jp�Se .l� " �G TENANT NAME(if Commercial}: ,rR s��, <br /> OWNER MAILING ADDRESS: srnee-r ?i,Z. �d 7`�' �J, �..L!�• <br /> cmr � !� �. srare �- va �� � <br /> OWNER PHONE: �'•2$•�J''�1.�' �' OWNER EMAIL: �� �, yr �. C .,Gb�„t <br /> CONTRACTOR NAME: � <br /> CONTRACTOR ADDRESS: srn� <br /> �- �, - . . <br /> CI1Y STATE Zp� <br /> CONI'RACTOR PHONE: CONTRACTOR EMAIL: __ , <br /> CONTRAGTOR L(CENSE#(REQUIRED): CITY OF EVERETT BUStNESS UCENSE#(REQUIREO): " <br /> PRtMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Flease Specify} <br /> CONTACT NAwfE: CONTACT PHONE: <br /> I�Ph��� �� �' CONTAC'�EMAIL: <br /> SU!lDING PERMIT APP1:1C/kT1±DN <br /> Existing Use of Buitdin : � Contract Price of Work:$ � C� �"� <br /> Proposed Use of Buiiding: 'fz Neat Source: ❑Gas ❑Electric DOther — <br /> Buitdin Type: ❑SFR-Detached SFR-Attached �Duplex ❑Multi-Famity-#of Units: �Commercial �Indusfiai <br /> T e of Projeci: ew DAddition ❑Remodel DRe air �t.l. ❑Si n ❑S rinkler ❑bemotition �Cha e of Use <br /> UESCRiFTiON OF WORK: �.y,�, ��y , /'a�L _ p/����� ��2,P7�/�� �,I ��� <br /> �.r�? �i^�-�»� �F <br /> / <br /> ��� � <br /> ASSOCIATED BUILDING PERMlT# if a plicable: <br /> MECHANICAL`.PERMIT APPLICAT�ON ,PLt�MBING PEI�IYflT APPLICATION < <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: ,_New Addn _Atteration _Repair <br /> #of List of Fixtures #of �S=af Ffxtcrres #°f List of�ixtures �°f Llst of Fixtures <br /> Fixtrrres Fixfures Fixtures F/xtures <br /> A/C-Air!-landling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air S stems Unit Hea#er Bsthtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin} Drinking Fountain <br /> Water Heater Refigeration Shower Floor Drain <br /> Gas Firepiace Woad Stove Kitchen Sinfc&Disposal Grease Tra <br /> Gas Range Ductin Dishwasher Roof Dcains <br /> Cbthes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Wood Water Weater Other: <br /> Exhaust Fan Sink(5ervice/Bar/Mopletc. Other. <br /> SPRINKLER f SUPPRESSI�N SYSTEM ( <br /> Number of Heads <br /> ACKNOWLEDGEMEIVT.•I have ieviewed this applicafion and con�9rm the information contained her�in is tnte and correct Work done pursuant to this permit must comply with <br /> current federal,state,and locai faw.The granUng of a perm#onty auU�orizes appmved wair and no devfations therefrom.Deviations must first be a�orized in wri6ng fiom the <br /> Building O�ciai befone being authorized under any circumstance.l am the owner,ar!am authorized by the owrrer of tivis property fo perform the work for which appticatio»is made, <br /> and 1 compty wRh the State Contractors Law 18.27 RCW and 296.20UA WAC. <br /> City of Evereft Otficial Use Only <br /> �j6T-�.., �..a�C� PERMIT# <br /> I z- r�.�� (o -- p <br /> OwnerlAud�orized Agent Signature Date (Revised 9/23/20?6) � <br /> �_ <br />