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��RI�i�T A,��L�G�►T{01� <br /> �4�9L��6�C� /�1�C�IA�LCA�.J ��l9YV��6i�G /�6G� 1��V�9i�8����/ �f�MOL9�'IOP� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@evereftwa.gov� www.everettwa.gov/permits <br /> ���u�ou-�a�c� a����ay�'����) ����������� �����mWv�,�� <br /> PROJECT SITE ADDRESS: �) e � �/L� �� ��k7 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (atfach copy of long legal description) <br /> �ONT�C`�' 9N�ORMATO�PI <br /> OWNER NAME: TEIVANT NAfVIE(If Commercial}: <br /> OWNER MAILING ADDRESS: sTReEr <br /> � CITY� � ' STATE � ZIP <br /> OWNER PHOPIE: OWNER EMAiL: <br /> CONTRACTOR NAME: �'j� 1; �/J <br /> CONTRACTOR ADDRESS: s-rReer ✓ <br />� CITY � STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): C(TY OF EVERETT BUSINESS LICENSE#{REQUIRED): <br /> PRIMARY CONTACT: L7 OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> �UILDIN(a PERMIT APPLICATI�N <br /> Existing Use of Buiiding: Contract Price of Work:$ S <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 ❑Sprinkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> G�� l ��r ��v �-� c� . b�� . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECFIAIdICAL PERMIT APPLICATION PLlJMBING PERMIT APPl.ICAT'IOPi <br /> Type of Project: _,New Addn _Afteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #of /�st of Fixtures #of Lisf of Frxtures <br /> Fixfures Fixtures Fixtures 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 Fioor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clofhes Dryer Hookups j Other: � }� Clothes Washer Medical Gas <br /> Range Hood Water Heater Ofher: <br /> Exhaust Fan Sink{Service/Bar/Mop/etc.) Other: <br /> SPit1�+9FCLE1�/SllPPRE��IO�d SY�TEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•1 have reviewed this appiication 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 granfing of a permit only authorizes approved work and no deviations therefrom.Deviations must frrst be authorized in writing from the <br /> euilding Official before being authorized under any circumstance.I am the owner,or I am authorized by fhe owner of this properfy to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 98.27 RCW and 296.200A WFl C. <br /> City of Everett Official Use Only <br /> � PERMIT# <br /> �i%��_ _� _ � �'/������ � .S <br /> O er/Author�ze gent Signature Date (Revised 9/23/2096) <br /> Y� � � � �l.--S <br />