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���9�dB`�'�1���9C,4�901 <br /> ��39���f�� / f���C�A6�6C��/ ��..�9��OG�� /�OGh�9 /���D�NGr���/ ��6�0�.0�"EOI� <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 /> ��9a�� o� �0��� 9u�C��av6y P6�aas�) P6���[������� ����f�M�`Y��E�9 <br /> PROJECT SITE ADDRESS: . r � '� q,� ; (� y ROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. attach copy of long legal description) <br /> ��6`J�f'��� ��f��RiU�e��0�e+9 - <br /> OWNER NAME: ' , � TENANT NAME(If Commercial): t=►A C.0"�V e� �,�}'�,l � <br /> OWNER MAILING ADDRESS: sTREer <br /> CITY " STFlTE 71P <br /> OWNER PHOPIE: �.�rj -�}�� ' e���� OWNER EMAIL• pY�✓�L1�ES �l�lS� �(,t,�'b � <br /> CONTRACTORNAME: j-1rg-� �� �, �'(i•� <br /> CONTRACTOR ADDRESS: sTReET T��11 a, , ti <br /> �v �" C�7y STATE ZIP �� <br /> CONTRACTOR PHONE: ��,t(� •7 I� - �3 ��I CONTRACTOR EMAIL: � t � ' q`L �t � L �C� <br /> CONTRACTOR LICENSE#(REQUIRED): 1`�'.S 1"(� `� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑ OTHER(Please Specify) �_�_ <br /> CONTACT NAMEl�� ,� CONTACT PHONE: �,'j} 5�j - � �5' <br /> ji•-GL ��1��� ��tl�iL CONTACT EMAIL: L— D}- f��''D�""CC�--b `� �c„� <br /> �UILDIldG PERIY01"r APPLICATION - <br /> Existing Use of Building: Contract Price of Work:$ �� � <br /> __ _—.::_---_ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric - �€-=-=---- <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �, �l. �-��-S ��� , <br /> ) __� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PE62M1'i'APPLICATION PLUMBING PERMIT I�PPL.l�ATION <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 #of Lisf 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 Firepiace 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 /> �PRIBe9FCLER/SUPPt�E��EO�a9 SYS'P�li� <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correcf.Work done pursuant to thrs permit must comply with <br /> current federal,state,and local law. The granting of a pe�mit only authorizes approved work and no deviations therefrom.Devrations must first be aufhorized in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorrzed by the owner of thrs properfy to pertorm the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200Fl WAC_ <br /> City of Evereit Official Use Only <br /> PERMI # <br /> , �9� � � �1-7 � <br /> , <br /> Owner/Authori d Agent S gnatur Date (Revised 9/23/2096) <br />