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� PERMIT APPLICATIC
<br /> BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<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
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<br /> I e�ow Bl�� k�� M ease �� �4 ��°���P�t�J E�T S�`'T� N�� M TI OT1 �?����� �` � ��"��t�������« 5�
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<br /> PROJECT SITE ADDRESS: �j S'j�� GU(�� /}-C.C` PROPERTY TAX#:
<br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description)
<br /> ��"� "� � '`*y ' C,ON'fACT71�fORMATI;ON, `
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<br /> OWNER NAME: �.�� � �}-� L L/L' !�✓f-i 1 T � TENANT NAME(If Commercial): [�( I�'Lo N C.�
<br /> OWNER MAILING ADDRESS: sTRee-r � � S7 I 3�"i �` �wh.tF S�, �
<br /> CITY � �LL, STATE L/...H"' ZIP � G D s
<br /> OWNER PHONE: r- OWNER EMAIL: i--'
<br /> CONTRACTOR NAME; �S
<br /> CONTRACTOR ADDRES : sTReer � �J
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CO OR EMAIL:
<br /> CONTRACTOR LICENS REQUIRED : � �l OF EVERETT BUSINESS LICENSE#(R IRE
<br /> PRIMARY CONTACT: ❑ O HER(Please Specify) /I�rtLG#�j('?�G"C".
<br /> CONTACT NAME: (2 o SS' S/Er�La S�N CONTACT PHONE: C� Z sl � a./S`�
<br /> �Z$ /2 I�"✓LC,-N'!?`��-'j',�J�LC CONTACT EMAIL: � �S � 'Z��L�t �cLc t��-t.c .L�rL . Lc vt� <
<br /> s ����`�;, rv = � � _z Bl`1;ILDING f"ER1�11'APPLICATION �� ` ' ,:�s ��
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<br /> Existing Use of Building: d —y�-4 r �t" „ Contract Price of Work:$ �'� fl��
<br /> Proposed Use of Buildin : 6 IGI G � R r , Heat Source: Gas ❑Electric ❑Other
<br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,F�£ommercial ❑Industrial
<br /> T pe of Project: ❑New ❑Addition ❑Remodel ❑Repair T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> � �/r- c 1-r��t. f� 6 1C'F-t c � ,8 v ! !�/wEi, �
<br /> A S S O C I A T E D B U I L D I N G P E R M I T# i f a lica b le : ({��h ���" � d �J-
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<br /> ��,��,���;1111E,G,H�1N��AL�P,ERMIT AP�P�L�IC�A��QNt°�`� �„�,,���r� $a�;�,`�.P,L�UMBII�G�P�ERI�I�T�APPL=1CATfOI���;���x� �,,`
<br /> Type of Project: New _ Addn _Alteration Repair Type of Project: New _Addn Alteration Repair
<br /> #of ��sf of Fixtures #of List of Fixtures #�f List of Fixtures #of List ixfures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handlin Units Heat Pump Toilet Bac Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub inai
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeratio Shower Floor Drain
<br /> Gas Fireplace Wood ve Kitchen Sink&Disp Grease Trap
<br /> Gas Range ing Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes W er Medical Gas
<br /> Range Hood Water ater Other: �
<br /> Exhaust Fan Sin Service/Bar/Mop/etc.) Other:
<br /> �,��SPRI�KL�ER'# _UPP�RESSION SYSTEM
<br /> Chemica r Water No. of Heads
<br /> ACKNOWLEDG ENT.•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 granfing of a permit only aufhorizes approved work and no deviations therefrom.Deviafions must first be authorized in writing from the
<br /> Building Offrcial before being authorized under any circumstance.I am the owner,or I am authorized by the owner of this properfy to perform the work for which application is made,
<br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A W,4C.
<br /> City of Everett Officia/Use Only
<br /> PERMIT# � �� �
<br /> d '�"' +r-�*- -~-. �t c. � � 'ZO L 7 __, Y. f..
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) �
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