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P�I�.�11'T A���L.lCA.`TiOi�
<br /> BU9L�}II�t�1 IVIECHl�NICAL/PLtDf�IF3ti�9G 1 SC(.��1 SPRINKL.�Ft I DE{�[OLiT10�
<br /> CITY OF EVERETT PERMIT SERVIGES
<br /> 3200 CEDAR STREET,EVEF2ETT,WA 98201
<br /> (P)A25-257-8890 � FAX 425-257-8857 �{�everetteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJLCT S1TE ADDRE;iS: �� � 2 PROPERTY TAX#:
<br /> Gir Iti
<br /> LEGAL for new consfntction: Short Pla�/subdiuision Lot No. (etEaafi copy af tong fegai description)
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<br /> OWN�R IVAME: �Yt.�{/"':.. `'.Z�U� `�YG� �6w SU� j(� TENAIVT 1VAME{if Commerci : � _�inS�-�'��`v� �
<br /> OWNER MAILING ADDRESS: STREET
<br /> CRY STATE ZIP �
<br /> OWNER PHONE: �j � °�.�j OWNER EMAIL:
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<br /> ' CONTRACTOF2 NAME: ?GiYl� �5 j � �C'�
<br /> CONTRACTOR ADDRESS: srReer � �2j
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<br /> CONTRACTOR PHONE: �ZS� (�t COPiTF2ACTOR ENlAIL: ,A�/�Crj IrI��J 6/9 � � 1 �'C��'�^�
<br /> COhiTRACT�Ft LICEAISE#(REQUIRED):'�t�t�Z S�L �✓��•-. C1TY OP EVERETT BUS#NESS L(CENSE#{REG2UIRED): ,�j I
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<br /> PRIMARY CQNTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) C5 ZS� � Of� '
<br /> CONTACT IVAME: � CO{VTACT PFiONE: 'j e�j I� r 3�}G I
<br /> � COIVTACT EIUtAlL:
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<br /> � � , Y`5 �., , � 1-� �UI�.�D.,�N_G.,{�PERMiT APP[:tG�Ti�1►� ; ;� $ � �
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<br /> Exisfing Use of Building: G� 'vt �,�i Contract Price of Work;$ �'���
<br /> Proposed Use of Buiiding: � Heat Source: Gas ❑Electric ❑Qther
<br /> Building Type: ❑SFR-Detached ❑5FR-Affached ❑Duplex ClMulti-Family�#of Units: �Commercial dustrial �
<br /> Type of ProjecY ew C1Addifion ❑Remodel ClRepair ❑T.l. ❑Sign ❑S rinkler ❑Demofition ❑Chan e o#Use
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<br /> DESCRtP710N aF IA/ORK: � L„ ����..,� �,Q� r, , �
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable)'
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<br /> Type of Project: _New_ Addn Alferation ^Repair Type of Projecf: ,_New Addn Alteration ,_,Repair s
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<br /> #of List of Fixtures #of List of Fixfures #of Lisf of Fixfures #of Lisf of Fixtures �
<br /> Fixfures Fixtures Fi�ctures Fixfures �
<br /> • A/C—Air Handiing Units Heat Pump Toilet Backf[ow Prevenfer Qnside Bidg) �
<br /> Forced Air Systems Unit Heater Bafhtub Urinaf
<br /> Gas Piping Boi(er Lavatory(Wash Basin) Drinking'Fountain �
<br /> Water Heafer Refrigerafion . Shower Floor Drain �
<br /> Gas Fir�place Wood Stove Kitchen Sink&D.isposal Grease Trap �
<br /> Gas Range Ducting Dishwasher Roof Drains �
<br /> Clofhes Dryer Hoolcups 4ther: Cfofhes Washer Medical Gas u
<br /> Range Hood �� Water Heater Other: il
<br /> Exhaust Fan Sink(Service/BarlMopletc.) Other: j
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<br /> ACKNOWLEpGEMENT.-t have reviewed fhis applica i n and confrrm fhe informafion contained herein is true and correct Work done pursuant fo this permit must comply wifh j
<br /> current federai,state,and locallainr.The granfi ermif only authorizes approved vrork and no deviations fherefrom.Deviations must�rst be authorized in writing from the �
<br /> Building O�cia1 before keing aufhorized u r a trcumstance_I am the owner,or!am authorized by the owner of this property to perform fhe work for which applicafion is made, Y
<br /> and i comply with the Stafe Confracfo aHl .27 RCW and 296.200A WAC �
<br /> ,,r� Cify ofEvereff Officiaf Use Only �
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<br /> Owner! ufh ' ed Agent Signature Date (Revised 90/92/2 95) �
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