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���9��T A��LBCATfO� <br /> ��9LD9N(� I i�i�C&-�ANECA�../ �9�lJVi��I�� /S9GN I S��Di���.�R/ ��Y�@OL➢�'I�� <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 /> (�9ue oe��I�ek 8n�s�r�8y�I�ase) P��J��`�'���'E �Gd���M��'�OH3 <br /> PROJECT SITE ADDRESS: � � � • �{.�� � � PROPER7Y TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �ON`f'A�� IP��ORMe4TIOR1 <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer <br /> - � CITY " STATE . � ZIP <br /> OWPIER PHONE: OWNE12 EMAIL: <br /> CONTRACTOR NAME: �g'j��1jr` � <br /> CONTRACTOR ADDRESS: s-rRee-r <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAtL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONi'ACT: �OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> �119LD1I�it9 PEi2MIT APPLICA'i'iON <br /> Existing Use of Building: Contract Price of Work:$ W <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑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 /> �.�� � �o� 1�� --� � . � . <br /> � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMI'H'APPLICATION PLUM�ING PERMIT APPLICATHON <br /> Type of Projecf: _New_ Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #of (rst of Fixtures #°f Lisf of Fixtures <br /> Fi�ctures Fixtures Fi�ctures Fi�cfures <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 j Other: �j� Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPR1�+8�CLER/SUPPI2�SSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�l have reviewed this application and confirm the information 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 permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being aufhorized under any circumstance.1 am fhe owner,or!am aufhorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.20oA WAC. <br /> City of Evereff O�cial Use Only <br /> �'/if PERMIT# <br /> � `�����" / '"�^����j� Q ._ <br /> � � <br /> O er/Authorize ��gent Signature Date (Revised 9/23/2096) ` ��� <br /> � r ` ��� <br />