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����ir����ic�rio� <br /> �uw��i��cH��ic�,�� P�.u��i�G � si��, , ., ��i�����i D�nno�i�io� <br /> CITY OF EVERETT PERMIT SERVII,LJ <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 Ink Only Piease) PROJECT 51TE IRIFORNI�TIOt�9 <br /> PROJECT SITE ADDRESS: (�: � PROPERTY TAX#:G�% �%u'�� (�>��' <br /> LEGAL for new co�struction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CON'rACY IPIFORNiQ►'TION <br /> OWNER NAME: k , 7 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s-rrzeer , j , ' � <br /> CITY `l f I �� STATE ZIP � � L� <br /> OWNER PHONE:ZL�.(� - (,�.( � — ��� ' OWNER EMAIL: � ,�� u�� �� �� �Z�7dH ur I-- L Lv <br /> CONTRACTOR NAME; 'j � � L � �_ <br /> CONTRACTOR ADDRESS: srReeT L L� � �;�- <br /> CITY � �� . � STATE ZIP � � <br /> CONTRACTOR PHONE: �' 7- LJ CONTRACTOR EMAIL: C= �L t� „�-',y� �,H �L � � L�-� <br /> CONTRACTOR LICENSE#(REQUIRED): (JL t'f1� � � CITY OF EVERETT BUSINESS LICENSE#(RE I IRED)C:d3C:� <br /> _.._:. . _.._.. ___. __. ..,._._... ___ _.._. _ _.,..._.. _ _ _ _.__._ . ...__..._ ._ _.... __ .. <br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME, CONTACT PHONE: � � ��� .'���� � <br /> ( `; r C�� . •�� CONTACT EMAIL: '�� ` ` r�� r� G �G�;/ <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <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 emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �L��t�.� �C'�'��� �� ��i�I li'L�v'i.,•�� � I�aci� �L.� r'y� <br /> ; <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f Lisf of Fixtures #�f Lisf of Fixfures #°f List of Fixtures <br /> Fixtures Fixtures Fixfures 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/SUPPRESSIORI SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�1 have reviewed this application and confirm the information contained he�ein is true and conect. Work done pursuant fo this permit musf comply with <br /> current fede�al,state,and local law. The granting of a permit only aufhorizes approved work and no deviations therefrom.Deviations must first be aufhor'i-red in wrifing from the <br /> Burlding O�cial before being authorized under any circumstance. !am the owner, or I am authorrzed by the owner of this property to perform the work for which application is made, <br /> and 1 comply with fhe State Contractors Law 98.27 RCW and 296.200A WAC. <br /> --� City of Everett Offrcial Use Only <br /> / ' ' `� PER �T# _ — <br /> � � z�l� ' ��� <br /> /Autho ized Agent Signature ate (Revised 5/20/2016) <br />