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PERMIT APPLICATIOI��
<br /> BUILDINC��CHANICAL/ PLUMBING /SIGN �tINKLER/ 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@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: 2 L,/� PROPERTY TAX#:O I O 3SO0 O�!6a
<br /> , LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br /> �,'r`� ` u ,���! n -�c�,,, �.i:-- -�.:'. .����li "'i(�r� ..,r�atryu�_};u 61��I d�������������"������i���4 ���n���l,.;;!'�i��;�.,"��.. ��d"��,�,�� �s � �' ���' ��. � i.
<br /> _.ai��r l.n,�,.,`. �, .;..+..�. y , .... ... N ,. .R- . �'rv�- � r.� ."°9 "�"`�hl��� .'.i"�'�.,-.n . � ii� fi `
<br /> OWNER NAME: i.f Q � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: • STREET � (� �p�p�l'� ^j
<br /> CITY i ('.'[`�' STATE � ZIP Z O
<br /> OWNER PHONE: f� OWNER EMAIL: 'N, d AJ
<br /> CONTRACTOR NAME;
<br /> CONTRACTOR ADDRESS: srReeT
<br /> CITY � STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
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<br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: �r/����� CONTACT PHONE: N� �.� ��d/
<br /> !
<br /> CONTACT EMAIL: �„��, ��, ed�,f�, �,�,�,��
<br /> � �� , � :� �I, . ni i i .m � � . � �ol' ":, ' � ��� �
<br /> � _Bu��a���.�E���T,���c.���►�1���`,:� . .
<br /> _ �
<br /> Existing Use of Building: N L - ewJG� Contract Price of ork:$ � �a �
<br /> Proposed Use of Buildin : N -F' ��L � !>CNFG�E Heat Source: �Ga ❑Other
<br /> Building T pe: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Famil �of Units: ❑Commercial ❑Industrial
<br /> T pe of Pro'ect: ❑New �Addition �Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use
<br /> DESCRIPTION OF WORK:GOM(��G7Z% $GK� -F�N�3�L�.r�;�wd'3'e'scRt•�/''�
<br /> �F.�°�i-rnr�J 5��c, �JG ADD j3A�R.5.�1t•SNvkk,iZ.. 3�4ri�Roch Jc�1��-_
<br /> RovG �a��Rmri�'j�n1�G
<br /> ASSOCIATED BUILDING PERMIT#(if a plicable :
<br /> MECHANICAL; ,E�tMIT APPLICq'�'lO�1_ �� ' � ; _`�„�, �; ti� m?.;�,PLI�MBiNG PE�M�T, PP�IC°,,TION', ,;
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of ��st of Fixtures
<br /> Fixtures Fixtures Fi�rfures Fiactures
<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) Drinkin Fountain
<br /> Water Heater Refrigeration 1 Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ductin Dishwasher Roof Drains
<br /> Clothes D er Hookups Other: Clothes Washer Medical Gas
<br /> � Ran e Hood Water Heater Other:
<br /> Exhaust Fan f Sink(Service/Bar/Mop/etc.) Other:
<br /> �•`; S�RI �i;�R(`S�lPP�ES�t�N SYS'�"EM ,: �
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.�1 have reviewed this application and confirm the information 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 permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Official before being authorized un ' umstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the State Contrac aw 18. CW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> � PER #
<br /> �-%�-j6 � __
<br /> Ow r/Author' d A Signature Date (Revised 5/20/2016)
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