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III' PERMIT APPLICATIC <br /> BUILDII�!I MECHANICAL/PLUMBING !SIGN /SPRINKLER t DEMOLITION <br /> �ITY QF�VER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E}everetteps@everettwa.gov r www.everettwa.gov/permits <br /> (Blue or Black!nk Only P(+ease) PROJECT S1TE INFQRM�4TION : <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> LEGAL for new construction: Shork PlaVsubdivision __.. _. Lo o,_,,,,^;, (attach copy of lon�le�al description) <br /> CONTACT INFORMATION <br /> _ �. . _ , ,.;._ . .. __ ... �_. <br /> OWNER NAME: TENANT NAME(If Commercial): ' <br /> OWNER MArLING�1DDR SS: STREET r -t <br /> s�tY ATE z� <br /> OWNER PHONE: OWNER EMAIL: <br /> __ _ _ <br /> CONTRACTOR NAME: _ 5 � _ <br /> CONTRACTOR ADDRESS: srn�er � � v <br /> arv srare ziP � <br /> CONTRACTOR PHONE; c�� � �-�-- CONTRACTOR EMAI�: S' e . �Yj <br /> COMTRA�TOFi L#�Efi�tS€�k(��tl�9iR�Q)i CITY O�'EVERETf E�tY3iP1E88 iCEN*sE#(i2EQU{RED}s <br /> PRIMARY CONTACT: ❑OWNER ❑CoNTRACTOR �OTHER(Please Specif�r) , 1. _ __ _ _.__ <br /> CONTACT NAME: �O �� CONTACT PHONE: ._ �_ <br /> � CONTACT EMAIL: ,�jJjS I�: {�6 U e � �,i� - �'- <br /> : �Ui��iN�M��AiI�`A�'1�L�i��lTi!`�1�i" <br /> . . _ _ _ : <br /> _ � .-. <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin Type: ❑5FR-Detached ❑5FR-Attached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of�ro}ect: ❑N�sw �Add9tion ❑Remod�l ORepair �T.I. �ign ❑�prirrkl�r C3Demolitior� QChange of Use <br /> DESC�I�PT11 ON OF WO�RK.:C � ` gt ���-- � �(-7�I�t7 (,t,(�,Q� , �t' <br /> ,u� �; � � 5 � �u b� LE� <br /> i��U.mi na�lia� . <br /> ASSOCIATED BUILDING PERMIT# if a licable: <br /> MEGNAN#CAL P��lM1T#�P!IN.#C/[T10N :` I�LUMBINO PlR�11f'i"�IRRlfC/k3'lON <br /> pe of Pro]ect: _New Addn _Alteration _Repalr Type of Project: New Addn Alteration Repair <br /> #of ��st of Fixtures #of ��st of Fiktures #°f L1s!of Fixtures #of Lisi of Fixtures <br /> Fixfures Fixtures Fi�rfures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> FQrced Air�yst�ms tJnit Heater Batht�b Urina� <br /> Gas Piping Boiler Lavatory{Wash Basin) Drinkin Fountain <br /> Water Heater Refrigeration Shower �loor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D er Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> �xhaust�an 5ink(�ervice/BarlRAoplet�.) flther: <br /> $P�RiNKI.lR{'S�PP��iSlfl►1�1$'�''$'i`�M <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this applicatiqn and confinn the information contained herein is true and correcL Work done pursuant to this permit must comply with <br /> current iederal,state,and toca!law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized Tn writing from the <br /> Buiiding O�cial before 6eing authorized under any circumstance.I am the owner,or!am aathorized by fhe owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cial Use Onty <br /> PER�#��Q <br /> 1 --1�' �" �C�2-- <br /> wner/ or e t natur Date {Revised 9/23/2016) I <br /> � i�2/ <br />