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PEFtMIT APPLIG,4TI0(^
<br /> BUILDING/�IiECHAMIGAL/P1.UM�ING/SIGN/SPRIIVKLER/DE6VIOLIYfON
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everefteps@everettwa.gov� www.everettwa.gov/permits
<br /> (Blue or�lack In[c O.n1y.Please) PROJECT SITE INFORMATION �
<br /> PROJECT SITE ADDRESS: �i�� �v��_ �� PROPERTY TAX#: DD�37���dI�d0
<br /> LEGAL for new construction: ShorE Plat/subdivision Lof No. {attach copy of long legai description)
<br /> . CANTACT.INFORMATION .
<br /> OWNER NAME: ��=�� "[D'►�N�`i � �D� 3�S TENANT iVAME(If Commercial): --��qyaq,g �z�
<br /> OWNER MAILfNG ADDRESS: sTReEr 2(g�/ �CVC: �t��
<br /> crn �U rs Y2-$('� sra� W/-E— zia �20
<br /> OWNER PHONE: OWNER EMAIL:
<br /> .._..,_....�.._...�_..,... ........,�..._.,.,_,.,�.............,�, _._...,�......._._....._.,.... ,...,.m,....__,...,..,..._._.................. - -
<br /> .... .._.... ........._._...,,.,.. .... „..,,.......,..:.,..,_.._. ... � ..,,,.�. ..,...,..._.,
<br /> CONTRACTOR NAME: C�(�(Z,C�(�-�� STta-T[� �7f�E�w(,bTA-cr
<br /> CONTRACTOR ADDRESS: STREET �LI°L'D �Gl� acU f�
<br /> � CITY IL U�yL�T STATE �/.� ZIP (��ZD
<br /> CONTRACTOR PHONE: �ZS-�L�j 2^�j(I CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED}: �v�(�.�5 p2,f�j CITY OF EVERETT BUSINESS LICENSE#{REQUIRED): W b s"
<br /> PRIMARY CONTACT: ❑OWNER I�.CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: �2 g_Zs2_���C�
<br /> M,il��� u�v CONTACT EMAIL: ��4,-�J.cCa '�j[�/��1�f}<�yc�
<br /> , . .. ,. . ,
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: ���-Cfs � Contract Price of Work:$ t�����
<br /> Proposed Use of Building: �l/O C��G'S Heat Source: BGas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: C�Commercial ❑Industrial
<br /> Type of Project: ❑New �Addition ❑Remodel f1�.Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolifion ❑Change of Use
<br /> DESCRIPTION OF WORK: •
<br /> tz�,�wv€ � R�t�e,� �I�t� ti�L�� s��-��-� w�-�� �'��. z-. �P�-1 fi S�S�`�� � �
<br /> �J � 1� (�O(.Y�rTL� �'c�A�1� t��� �V L� MA t>>c1771� b l� �Si 0��,1,ti.�
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): '�l`� V� i'�'J�'i� �V� � 1"'fc(�f� Lv'r� v,�+(T
<br /> .. .
<br /> ' .MECHANICAL.PERMIT APPLICATION PWMBING PERMIT APPLICATION •
<br /> Type of Project: _,New_ Addn _Atferation �,Repair Type of Projecf: ^New _Addn Alteration _Repair
<br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures �°f List of Fixtures
<br /> Fixtures Fixtures Frxtures Fixtures
<br /> A/C—Air Handling Units Heat Pump Toilef Backflow Preventer(Inside Bidg)
<br /> Forced Air Sysfems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Wafer Heafer Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kifchen Sink&Disposal Grease Trap
<br /> Gas Range Ducfing Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Ofher: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other.
<br /> S�RIIVIP�l.�R/�IJP�R���I6iV �SY�I�ithl
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•1 have reviewed tfris application and confi�m the informafion contained herein is true and correct.Work done pursuant to this permit must comply with
<br /> current federal,state,and local law.The granting of a permif only aufhorizes approved work and no deviations therefrom.Deviations must first be authorized in writing f�om the
<br /> Building O�cial before being authorized under any circumstance.!am the owner,or I am authorized by the owner of this proper(y to perform the work for which applicafion is made,
<br /> and l comply with the Sfate Contractors Law 98.27 RCW and 296.200A WAC.
<br /> City of Everetf Offcia!Use Only
<br /> � �_�� PERMIT# � , �
<br /> C�� - 7- '� �D D�
<br /> n�in T/Aufhorized Agent Signature Date (Revised 5/20/2096) � /
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