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���a�0�����..8���0��U <br /> ��99�.�91�9� / f���G-O�Ii91C��/ f���il��9Vl�� /�9(�fl� /��R9�flGo���/ �fEil�d0�0�°oOlr� <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 /> Q�9a�� o� �la�� Bu�Fa��8� P6e�s�) P���J���'�@'Y'� ��l���Gil��,'�'9�R9 <br /> PROJECT SITE ADDRESS: ��I � 1j <;'�,-__�' �'C'. rC,*�',-� � PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ��E���G`� 9G`��OR�dA�Y�P�9 <br /> OWNER NAME: ,/`, �'.,, ��,` �,� �?�� 1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREEr �',� ���r �--- ,1�F �,�� 9� <br /> CITY �G<�,� �'��''���^ STATE �'' ZIP �� <br /> OWNER PHOiVE: OWNER EMAIL: �YJ._ �/a�._ ����;!� � �,�„�,� , n <br /> CONTRACTOR NAME: �'���� � �� <br /> CONTRACTOR ADDRESS: sTrzEET <br /> C�Ty 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 /> �UOLDIBdG PERNlIT AI9PL.ICA'�ION <br /> Existing Use of Building: Contract Price of Work:$ �- �n����`� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: � � � � ��f ��r c., <br /> r �`�:��,..�� C C'G L'% <br /> �' /� � ��--�1, <br /> c�1�7�-�� ���: � -_ ��' 'I� <br /> t p � �� I <br /> \n.�.�-��,t�V �--'� �, �. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> IVIECH�1P�lICAL PEm2M1'i'APPLICATION PLUMBING PERMIT/�PPLl�dYIOW <br /> Type of Project: _New _ Addn _Alteration Re flir Type of Project: _New _Addn _Alteration �pair <br /> #°f List of Fixtures #of t of Fixtures #°f Lisf of Fixtures #°f isf of Fixfures <br /> Fixtures Fixtures �' Fixtures Fi�cfures <br /> A/C—Air Handling 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 Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dis sal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer J�Ibokups Other: Clothes W�her Medical Gas <br /> Range Hood Water yeater Other: <br /> Exhaust�n Sin �Service/Bar/Mop/etc.) Other: <br /> SPR�FfL@F2/SUPPRESSI�N SYST�IUI <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.'1 have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant fo this permit must comply with <br /> current federal,state, and local la�i. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must frrst be authorized in wrifrng from the <br /> Building Official before being authorized under any circumsfance.I am the oUmer,or I am authorized by the owner of this property fo perform the work for whrch applicafion 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 /> �� . 'i�l���'�-��`_ � , � P E T# � ;� �� '���� <br /> �� <br /> � ��� � i � L� C� <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) �=r 4 <br /> ill I <br /> i � <br />