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���n�o�-����ic�-rior� <br /> �UILDING /fViEGHANICAL/ PLUM�ING /SIGN /SPRItVKLER/ DEMOLIT'IOM <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 /> {Blue or Black Ink Arvly Please) PR6J�CT SITE INFOftMAT10M <br /> PROJECT SITE ADDRESS: � N Q � �{��,R� �r OPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> GON'PACi' INFORMATION <br /> OWNER NAME: �y TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer p0 G�/. �, . <br /> CITY E STATE � ZIP q$Z,O <br /> OWNER PHONE: �~y � S•33Q•�� OWNER EMAIL: <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: sTReer , O S�1 PA�RKw <br /> CIN RN �, STATE � ZIP Z y <br /> CONTRACTOR PHONE: '3�jQ! u—(��4 CONTRACTOR EMAIL: � Q � V <br /> CONTRACTOR LICENSE#(REQUIRED): L CITY OF EVERETT BUSINESS LICENSE#(REQUIR ): <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3(QQ�QZ(�••�O�{,��. <br /> � SON �UG� CONTACT EMAIL: ' � � � <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ . � � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family�#of Units: ❑Commercial ❑Industriai <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTIONOFWORK: ��y�p�=kT M/�►1� U�A�►OL RSP4�t�INCsr GOeuw�6t� y'iwCR CT"Z <br /> wITN �IfR. �,so�.tp GN1��� ffrR G�9Mf'oRT c,oe�INt� � TNL NO-�f I. 7'7�1'!.. VwriT <br /> �5 Lss.�►.'r'�p tXTtftN.4t,.t.�I eN 7�Fti Ro�F ot rHL 4o-yt B�t�O�Nt+�. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn Alteration _Repair <br /> #of Lisf of Fixtures #of List of Fixfures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures 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 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/BadMop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <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 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 befo�e being authorized under any circumstance.l am the owner,or I am aufhorized by the owner of this property to perform the work for which application is made, <br /> and I comply with fhe State Contractors Law 98.27 RCW and 296.200A WAC. <br /> City of Evereft Offcial Use Only <br /> PERMIT# <br /> , oo sr r � 1 ����� <br /> Owner/Au orize Date (Revised 9/23/2016) ` ~ ~ �`+Y <br /> �� `�/�f. <br /> 6 , <br /> _.._..- <br />