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P��[ldil�AfP�L9CATl0�l <br /> �lJ9LDl�V I 1�9�CHA�91C�aL I �L116��Ii�G I SIG�4 /���2��IP��.ER/ DEfl�O�ITBOY� <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 /> (�lae� or �IacBs 9�v9s �n6y �fe�se) ����H��`�'�9�� a6d����/1�`PS�R4 <br /> PROJECT SITE ADDRESS:7(p b � �/'ey' /'�r, 1�4 ; � '�Y% PROPERTY TAX#:2$0507p0�O b?OU <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (attach copy of long legal description) <br /> COFdYAC�' Y1dF'OFti�llAT006� <br /> OWNER NAME: � �, �h.���r'S ��`�' �Q. -�j TENANT tdAME(If Commercial): v(.L„[�Gty�'� <br /> OWNERMAILINGADDRESS: srREEr S3�S S� 1��a�[at..�S^ 5���'G 2°�S <br /> CIiY �,(�,�, �SW O STATE v� ZIP ��O "3 J <br /> OWNER PHONE: �j O3 (p('�3 — �� 2j OWNER EMAIL: (�c,�- l�a.��o�'1 r �y��, Ct.►1� , (r0 <br /> CONTRACTOR NAME: �'rC.o✓� �,G,1,�4'�" �, r��c.w�t,v�--'F' <br /> CONTRACTOR ADDRESS: sTReEr 21 D� �2"l�' E v��'G � <br /> CIN �c,1���/l,l,� STATE ��7 ZIP $OT�� <br /> CONTRACTOR PHONE: �'(`LS— S � I (o S3 CONTRACTOR EMAIL:' �,,��lSo� Q{"Lo✓1—'rl . LO wl <br /> CONTRACTOR LICENSE#(REQUIRED):CC �}(�CoNTI g(04 L'l CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): OS�S�oO <br /> PRIMARY CONTACT: ❑OWNER �I CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �y,Z _�j$�f— $'l6$ <br /> J D✓� W.I ba'^ CONTACT EMAIL: ` �„y<<„�c a.•,,Q-C�.r—Lc3yt ,,.}-1 . G..�ry.� <br /> BIJILDIMG PERM17 APPLIC/�YION <br /> Existing Use of Building: �QLCtW�.� Contract Price of Work: $ �"} O�0 <br /> Proposed Use of Building: pGr�w Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�#of Units: �Commerciai ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler �7Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: ��p��4�� � .�{�� �v;� ;r�.� , ��� �i� � c� � , <br /> � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ��G' S� <br /> MECHANIICAL PERMIT APPLICATION PLUMBING PERMIT APPLI�A710N <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures ��f List of Fixtures #of List of Fi�ctures #°f Lisi of Fixtures <br /> Fixfures Fixtures Fixiures Fixtures <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 Founfain <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 /> SPRIIdKLER/Sl1PPRESSIOPJ SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:/have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply wifh <br /> cur�ent federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must firsf be authorized in writing from the <br /> Building Otficia!before being authorized under any circumstance.I am fhe owner,or l am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply wifh the Sfafe Contractors Law 18.27 RCW and 296.20oA WAC. <br /> City of Everelt Officia!Use Only <br /> � � PERMIT , <br /> � ��lzol� �[ �?0�` �C��� <br /> Own r/A orized Agent Signature Date (Revised 9/23/2016) <br /> I�7i <br />