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PERMIT APPLICATI <br /> BUILDII�I I MECHANICAL/ PLUMBING /SIG RINKLER/ 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.everettwa.gov/permits <br /> �1�r��r,t3taci�.#r�t�~���r P1��s�j P#�C��1E��'S�T� �1+1F'�l��t�Tt�N <br /> PROJECT SITE ADDRESS: g a..� � -L_ PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> '�#'►�kW'�"/��r'�`i�F`�I�MA'�`�f�i�I <br /> OWNER NAME: � G � S L,� TENANT NAME(If Commercial): S � �/G' S <br /> OWNER MAILING ADDRESS: STREET l'/ /�a S.? <br /> CITY����P f STATE �„ ZIP T��G <br /> OWNER PHONE: '� " ,� - S�OO OWNER EMAIL: <br /> CONTRACTOR NAME; �f✓`A S s�� � jt, <br /> CONTRACTORADDRESS: srReeT �",.s/,$' - 7`�F G,C S�' <br /> ��N `��/� O S STATE l/L� ZIP / a��G <br /> CONTRACTOR PHONE: � S-�� G��� CONTRACTOR EMAIL: Q�, f^Q S o2 02.�I��y•C O�j <br /> CONTRACTOR LICENSE#(REQUIRED): /r L �f IL� I, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):QS.Z ,32 <br /> . ,.. __ _,.�, .. .. . „_.,___ _ ... �, _�.._ � ,.-_. �_ <br /> PRIMARY CONTACT: ❑OWNER ,�.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �3 � �� <br /> (�(/C ti 7 �/"q S CONTACT EMAIL: 01 f/�"�� 02-��/��.5'ti . �'C.� <br /> ` ;; . . _ ;. ��IT��MI��ir'P�RI�l1'�`�#PPL�'�"�1�;,_; - <br /> : . . . - . :_.: _ .. _. _._: <br /> Existin Use of Building: G �- � .S��t c� Contract Price of Work:$ <br /> Pro osed Use of Bui4din : S � -G Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: ommercial ❑Industrial <br /> T e of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.i. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: � N,��,�� LG � / <br /> ����G'C�. f / s�/ !i1//7�''t yC z... L,��%, /.� <br /> t"°cSo. /��.y4�G G� � - C1�'���ri e i^ GOSd ov�'7`� ,�1/'r�w L �� �/..�0' <br /> ASSOCIATED BUILDING PERMIT# if a licabie : <br /> . n�r�+c��tai��n����a�����ra�:: = �r.u��rr�c�P�����r m��►�.��i�r��r�r=: <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn Alteration Repair <br /> #of ��st of Fixtures #of List of Fixtures #of List of Fi�ctures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato (Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposai Grease Srap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Mo /etc.) Other: <br /> �PR�I�I��ER.t��R#�1�E��#��SY�"�"�1: <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this applicatron and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> cu��ent 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 /> 8uilding Official before being aufhorized under any circumstance.I am the owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ^�/ PERMIT# <br /> 7-� 6 al C� 0 `�'(��1 � <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) � <br /> � <br />