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P���6doT A��L9C�►l"90� <br /> �lJBL.DBNC� I i�li ECI-@AFt11CAL I P�111�1�11�C� /SICN I�P�SYVI'�nLER/ Dl��V60L��'lOi�B <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetfeps@everettwa.gov� www.everettwa.gov/permits <br /> (�lu�ae��lack 1�6��n6y�9ease) ���J��`�'�I�� 1�9���I�iA'�'i0� <br /> PROJECT SITE ADDRESS: ��} �ft j• �/'�.:� �j � "l� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legai description) <br /> COt�'TA�9° 1&V�'ORti�A'I'I�PI <br /> OWNER NAME: TENANT NAfVIE(If Commercial): <br /> OWNER MAILING ADDRESS: srReer <br /> � 41TY ' STATE � � ZIP <br /> OWNER PHONE: OWNER EMAiL: <br /> CONTRACTOR NAME: -�'p�(/d�1�J � <br /> CONTRACTOR ADDRESS: s-rReeT <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR L(CENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY COPJTACT: 0 OWNER ❑CONTRACTOR ❑OTHER{Please Specify) <br /> CONTACT iVAME: GONTACT PHONE: <br /> CONTACT EMAIL: <br /> �IIIL,DING PERMIT APPL9CATI�H7 <br /> Existing Use of Building: Contract Price of Work:$ �5�� <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 /> Gl.�� � �0! ��t/ �-}� C� . b�'� . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANIGAL PERMIT APPLICATION PLUMBING PERMIT t4PPl.ICATION <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: _New Addn _AlteraEion _Repair <br /> #of List of Fixtures #of List of Fixfures #of List of Fixtures #of Lisf of Fixtures <br /> Fixtures Fi�ctures Fixfures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Wafer 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 E�"i Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRII�i94LER/Sl1PP13ES�10Qd SYS`�EM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I 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 loca!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 Officia!before being authorized under any circumstance.I am the owner,or l am authorized by the owner of this properly to pe�form the work for which application is made, <br /> and I comply with the Stafe Confractors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> / � ' � ` � /i.����f PERMIT# <br /> / � i -� �,' ..� <br /> O er/Authorizec�Agent Signature Date (Revised 9/23/2096) <br /> � ��� r ��� <br />