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-, . PERMI7'A►PPLICAI'10��I�II <br /> BUILDIN�ECH,4NIC�lL.1 PLUMBING/SIGN �'PRINKLER/ 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@evereftwa.gov� www.everettwa.gov/permits <br /> (Btue or Black ln�z Only Please) PROJEC'i'�IYE Li�FAFtM,�#TIOM <br /> PROJECT SITE ADDRESS: �...���..t ( �..� �j�� PROPERTY TAX#: ��C1 SyI�OZ} IO3 �.Ol� <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (aftach copy of long legal description) <br /> CORITI�C7'IWFORMATIOPI <br /> OWNER NAME: ��� (���i �C:. �"'�j� , TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srreeEr �j �j �'L <br /> C(TY �v���� STATE W� ZIP � G_L.1` <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; T�� <br /> CONTRACTOR ADDRESS: srReEr <br /> ciN STATE zia <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): • <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTNER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �Z j-- 2�'3 .. � ` '�`�"� p J,i�, <br /> �-�p�� � ��'-'�� CONTACT EMAIL: ,���.� � � .LL/ � , �. <br /> BUILDING PERMIT APALICATION <br /> Exisfing Use of Building: 3-rvi� �T Contract Price of Work:$ � <br /> Proposed Use of Building: S�j-cv�� Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Aftached ❑Duplex Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ClAddition ❑Remodel ❑Repair �T.I. ❑Sign ❑Sprinkler ❑Demolition �Change of Use <br /> DESCRIPTfON OF WORK: �^ j y <br /> � � "C.+�H �"=�" l✓ 1`� • '. <br /> (� n� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): � 'rj '�"� <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPlICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Aiteration Repair <br /> Fixfures Lisf of Fixtures Fixfures List of Fixtures Fixtures ��sf of Fixtures Fixtures List of Fi�ctures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Prevenfer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bafhtub Urinai <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Heater Refrigeratian Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clo#hes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/efc.) Other: <br /> SPRINKLER/$UPPRESSIOId SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed fhis application and confirm the inforrnation confained herein is true and correct.Work done pursuant to this permit must comply wifh <br /> currenf federal,state,and local law.The granting of a permit only authorizes approved work and no deviations fherefrom.Deviations must first ba authorized in w�ifing from the <br /> Building Offrcial before being authorized under any circumstance.I am fhe owner,or I am aufhorized by the owner of this properly to perform the work for which application is made, <br /> and!comply wifh the State Contracfors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia/Use Only <br /> ` � �� � � PERMIT# ( <br /> � ������` � <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2 96) <br /> 1��Z_ <br />