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����i�,����'c�,��aoF <br /> f�Ul��li�c� I ��CHA�IICAL I �LIJflii�li�G I SI(��I / �Pi�li�K�EG2 I D�i�101_ITIOG� <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 /> (�Isae oe-�lack �ea��n9y �l�as�) ���J[�C`�'�1`�'E� iRl�O�OVI�'PI�It� <br /> PROJECT SITE ADDRESS: y'(;.� �j �-��y� �{-r'v1 LL:L�� �3-�-u.�� Z� Z PROPERTY TAX#: �)�j ' L-� U [� ti- �} � <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �ot��'�c�' a��o���Ya�� ' r Lc?�" �LC. <br /> � ! , <br /> OWNER NAME: �', i�.�(�• � �,': .C. ;'c TENANT NAME(If Commercial): � � j�� ��p'r"'(ti;;"I_,�,,� <br /> OWNER MAILING ADDRESS: sTReEr � � �'� ",�i'�;�,���'C'� ) �,�-ttt- ` ��,��, Z C Z Ar <br /> �—� U ,,. <br /> CITY " U(�,��;' l STATE �,I � 71P �' y� r�G� t� <br /> OWNER PHONE: �—��, � {- �j GO � OWNER EMAIL: <br /> CONTRACTOR NAME; Q f�(��"�' b`"��,' f'�<,�'�, --, <br /> CONTRACTOR ADDRESS: sTREEr � i ��1 ,�U � S C� <br /> CITY � j � STATE �J C^� ZIP C� �� <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): --- <br /> PRIMARY CONTACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: � � y�.� t ' t� <br /> � <br /> � ` ^� ��'�, CONTACT EMAIL• �'' : 'C> � <br /> �,�Ul)C.U�C�, �u 1 4 I� �� . _ ,'1i�,�._iG'Y1Ci,41!�'L 'l,{_, �3 � iJ1'2Qi .�t c�� <br /> BUILDING PERMI'T 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 ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �ArVL� � c�"`� cn^-a� S ��-�� <br /> ASSOCIATED BUILDING PERMIT#(if appiicable): <br /> MECHAPIICAL PERMIT APPLICATION PLUMBING PERMIT APPLI��iT10N <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 Lisf of Fixtures �°f List of Fixfures <br /> Fixtures Fixtures Fixtures Fiatures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinai <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%Mo /etc.) Other: <br /> SPRITI6(LER/SUPPRESSION SYS7EM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the informatron contained herein is true and correct. Work done pursuant to this permit must comply witl� <br /> current fede�ai,state,and local law. The grantrng of a permit only authorizes approved work and no deviations therefrom.Deviatrons must frrst be authorized in writing from the <br /> Building Otficial before being aufhorized unde�any circumsfance.l am the owner,or I am authorized by the owner of fhrs property to perform the work for which application is made, <br /> and l comply wifir the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everetf Official Use Only <br /> � PEf�jdff�j# � <br /> `�J ,,,, <br /> Owner/Authoriz Agent Signature Date (Revised 9/23/2016) <br />