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<br /> �IIOLDBi�G I f�1ECHAfVICA�/ �Ll�i�fd�l�l2� / SI(3N I �PRI�l�LER / D��liOL9TIOP�
<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 /> (�lue or �lack In� Orsly �lease) PR�J��`T SITE 9NF01tMAT'10�
<br /> ROJECT SITE ADDRESS: ' �/�%j �'�/��'.j.�- �'�j� � n � � f� 1 ",�I pROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> �ow�°,�c� I��oRn��roo�a p
<br /> OWNER NAME: �'` i,Y� ' �' �� �,.� TENANT NAME(If Commercial . '
<br /> OWNER MAILING ADDRESS: sraEET �-� � S . � � � `C �j�
<br /> CIIY �' �� � STATE � � ZIP � CI�.��
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: �� � � ' � ,�,
<br /> CONTRACTOR ADDRESS: srREei � I�� � i �- -7� �
<br /> CITY ��1��4� � 'r STATE ZIP '� •� U
<br /> CONTRACTOR PHONE: ��J �J CONTRACTOR EMAIL: r ',�"�', � S-�{f' ,� I(, ,��,�j�,,'`
<br /> CONTRACTOR LICENSE#(REQUIRED): I O EVERETT BUSINESS LICENSE#(REQ IRED): �
<br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑ OTHER(Please Specify)
<br /> CONTACT NAME: . CONTACT PHONE: ��p ,d:�y��- �� ' L�
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<br /> �,.' `����,,,. �, ��`�' coNTacT Ema,i�: c�'_i^�v�� C� � (I(. , f ,�!'✓�_
<br /> BUILDING PERMIT APPLICA'rION
<br /> Existing Use of Building: Contract Price of Work: �� J• �`��,�
<br /> Proposed Use of Building: � I�n��� " � Heat Source: ❑Gas lectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> � DESCRIPTION OF WORK: i � �a -�LU�� -r'G ��� ��, � I�'� L �GtG�I� "�'d;,4 � �' � I I1,1)� ���
<br /> �G��I �� �2 Ql��,t�t�v�,c � i '�� �V , � WC�. �
<br /> r����� � ����-��n�� �C ��'�t a� S�G���� - �L U����a-i u�v��J 1�v���t �� -��r �f+���L <<Z+���� . z. v-t��-�V���n�,
<br /> �ditii�c � fu,l-� �, Siv���> 5�1�,�vt�-y , ctiv�el r�nti ol-��^,���;i�,� v��t+i� ��u +�Y���t�� , ��v�r �vnll ( ')
<br /> ASSOCIATED BQJILDING PERMIT#(if applica�le): � '
<br /> MECHAN9CAL PERMIT APPLICATION PLUMBING PERMIT APPLlCATION
<br /> Type of Project: _New � Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of List of Fixtures #�f List of Fixtures #�f List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixfures
<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&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/ SUPPRESSION S1fSTEM
<br /> Chemical or Water No. of Heads
<br /> ACKNOWLEDGEMENT:I have reviewed this applica}ion 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 under any circumstance.I am the owner, or I am authorized by the owner of this property to perform the work for whidi application is made,
<br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of F_verett Official Use Only
<br /> �, ^ , :� � � ,�,1 � ., PE M� #< < 2
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<br /> Owner A horized Agen Signature Date (Revised 9/23/2096) �-1 \
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