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��V�6�d8�'���fl�9CA`T90h� <br /> (����.��R�(� / �d�C���19CA�I ���9B�d�l�1� /�9C��9 /��f�B�G�'�.E�1 ��ii���.��°BOY� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@evereitwa.gov� www.everettwa.gov/permits <br /> �����o��e���a����a������e� ��������'�� �����m����� <br /> PROJECT SITE ADDRESS: I `� �O Y'V1 ✓�-�'V�e. PROPERTY TAX#; <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �ON��C`�°' IN��RIi/9A7'I�QV <br /> OWiVER IVAME: � �Wl G� Qt WL(�C,L TEiVAiVT IVAIViE(If Commercial): � �� <br /> OWNER MAILING ADDRESS: sTReer (3 a 62 'Y' S � <br /> � CITY ���j STATE t/'�/ % _ ZIP � �dV <br /> OWNER PHONE: �Z5 � �J C>�G OWNER ENiAIL: �1 wj e C� � /�Sy` �� <br /> CONTRACTOR iVAME; C?L'`���� <br /> CON7RACTOR ADDRESS: srReET <br /> crrv STATE ziP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): ��� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> �I1ILDIMG PERMIT d�PPLICA'1'ION <br /> Existing Use of Building: Contract Price of Work:$ � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�of Units: ❑Commercial ❑]ndustrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � ����,, � � j_�'�! �� <br /> r e r t�� <« ,,�� G�� ��-► � � � �� <br /> ASSOCIATED BUfLD1NG PERMIT#(if applicable): <br /> MECHANICAL PEItMI'�'/APPLiCAT10N PLUMBIN(� P@RMIT APPl.l�I�"i'ION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of Lisf of Fixtures #�f List of Fixtures #of List of Fixtures #°f Lisf of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC—Air Handiing 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 Fioor 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: vVCt +' <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINIKLEiz 1 SUPIPRESSBOIeI SYS'T'EM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.�i have reviewed this application and confirm the informafion contained herein is true and correct.Work done pursuant to this permit must comply wifh <br /> current federal,state,and loca!law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Officia!before being authorized under any circumstance.!am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Stafe Contrac Law 98.27 RCW and 296.200A W.4C. � <br /> City of Ev'eretf Official Use Only <br /> C � � PERMIT �� <br /> �z�c � g� ` <br /> Owner/Author' Agent Signature ` Date (Revised 9/23/2096) <br />