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PERMIIT`4PPL.IG,�1'101�
<br /> BlJILDING/�LIIECHAIVIC�►L/PLUfVi�ING I�IGN/�PRINKLER/DE9ilIOLIYIOid
<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 /> (Blue or Black Ink O.nly_Rlease) PROJECT SITE IIVFORMATION
<br /> PROJECT SITE ADDRESS: ��ii (,iP ,�I'4�*�+, ' � PROPERTY TAX#: ���(�t��f�L��
<br /> LEGAL for new construction: Short Plat/subdivision Lof No. (attach copy of long legal description) �i �R 2
<br /> .
<br /> � CANTACT.INFORMATION
<br /> OWNER NAME: ��� ��7Z�?� � TENANT iVAME(If Commercial): `�� 1LlQ- #���
<br /> OWNERMAILINGADDRESS: s-rReer �„f3�_ ����,_„ �"`
<br /> cirr ����(�j(:�- s-ra� jt�.J ziP 0'?�SZ
<br /> OWNER PHONE: (:WNER EMAIL:
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<br /> CONTRACTOR NAME; C U Wrc.GV�-l�� 5?'!A'T[� �7f�EEZ-fM,6'1�A�G
<br /> CONTRACTOR ADDRESS; STREET 2I'L�O AGl� AcV�
<br /> CITY �1✓UGYL�- STATE �/�.. ZIp ��ZO
<br /> COtdTRACTOR PHONE: '^C 2S-Z�j 2��j(I CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REG2UIRED): �(��(,.�5 p22v CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): fj b �j"
<br /> , . .. .. .. ... .. . _ . , .. ., . . , _ _. , . .. ., , ,. ,. ......_�.. ..,,...... __... ,.,_. .._..._�_ ._,...,_
<br /> PRtMARY CONTACT: ❑QWNER I�.CONTRACTOR ❑OTHER(Piease Specify}
<br /> CONTACT NAME: CONTACT PHONE: �2 S-2S2'�7���
<br /> JVI,q�� � �j� CONTACT EMAIL: �if�j� �',��j/��,�QY�r
<br /> . BUILDING PERNIIT APPLICATION .
<br /> Existing Use of Building: (.( � Contract Price of Work:$ `� J
<br /> Proposed Use of Building: 1`1/Q '� Heat Source: $IGas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commercial ❑Indusfrial
<br /> Type oF Project: ❑New DAddifion ❑Remodel L�LI�Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> C��U� � I�p�� ���u 6 �-t� � �"tcs� � wl ��� � ��
<br /> �, ��5 �1.ec� ���r u���,5 �� u,���s �` �
<br /> o� c?u,,� t�� ��y« g�3`
<br /> ASSOCIATED BUILbING PERMIT#(if applicable):
<br /> ..
<br /> ' .MECHANICAL.PERINIIT APPLICATION PLUMBING PERMIT APPlICATION
<br /> Type of Projecf: _New Addn A►teration _Repair Type of Projecf: ^New _Addn Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixfures
<br /> A/C—Air Handling Unifs ' Heat Pump Toilet Backfiow Preventer(Inside Bldg)
<br /> Forced Air Sysfems Unit Heater Bafhtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heafer Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kifchen Sink&Disposal Grease Trap
<br /> Gas Range Ducfing Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medicai Gas
<br /> Range Hood Water Heafer Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRIIVP��.gR 1�IJP�R���leFl��P�`t�l�fl�l
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confirm fhe informafion 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 permif only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Building Offcial before being authorized under any circumstance.l am the owner,or I am authorized by the owner of this properly to perform the work for which application is made,
<br /> and!comply with the Sfate Contractors Law 98.27 RCW and 296.200A WAC.
<br /> City of Evereft Official Use Only
<br /> /'� PERMIT# �D �
<br /> ^'�C�,r �/3 �� .
<br /> �er/Authorize genf Signature T�ate�- (Revised 5/20/2096) /
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