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P�RMI�'APP�.YCAI"1C7N <br /> ��99LDlNG/I��GH�►NICA�I PL.IJ�lli�ING /S1C�iV /��R9i��LER/ D�i�{OL@�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@everettwa.gov� www.everettwa.gov/permits <br /> (�le�e oa��6acls Ink gn9y Plea��) PR�J��`�'S17'�9NF��MA'�9�td <br /> Pl20JECT SITE ADDRESS: (j�7��� �✓��'$�' /t'1�'i�D W�4 �'Z'� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lof No. (attach copy of long legai description) <br /> COfV�f�lC'T itdFORMAT109o1 <br /> OWNER NAME: � (U , �f�_ �(a �j ,�S TENANT NAME(If Commerciai): �,�cLC� � �D�Ie�1 ���' <br /> OWNER MAILING AdDRESS: sTReer <br /> p�7y ' � STATE ZIP <br /> OVVNER PHONE: OWNER EMAIL: <br /> � ` <br /> CONTRACTOR NAME; 1 " T r te C r�C>'^i t/� `'�J/ <br /> CONTRACTOR ADDRESS: s-rRe�r <br /> � ��7y � STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):� <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR THER(Please Specify) ��I� <br /> CONTACT NAME: CONTACT PHONE: �� �- ���" � �� <br /> �y�e �. �,g/�j�S CONTACT EMAIL: ��Q�jqP �j C e k� l/I I��i.`✓8 -�� <br /> BUILDING PERMIT APPLICA'H'ION <br /> Existing Use of Building: �/�rv�e, Contract Price of Work:$ Q�d <br /> Proposed Use of Building: �j�'an,:� y'�r,� Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Aftached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair .I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �o+��t�' �i N� c, Vha�O ���5�� � � �vt h rum�► r- G�d �1c�a.u.5f' �v1, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PI.UMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #�f Lisf of Fixtures #of Lisf of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bafhtub 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 Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink{Service/Bar/Mop/etc.) Other: <br /> SPRIRIKLER/SUP�RESSIOIV SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEIVIENT.•1 have reviewed this application and confirm the information contained herein is frue and correct.Work done pursuant to this permit must comply with <br /> currenf 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 authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this properly to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 98.27 RCW and 296.200A W.4C. <br /> ��'`y City of Evereff Officia!Use Oniy <br /> � PERM�J,� <br /> ' �-��� � � ' �VC l 7� .� � <br /> OwnerlAuthorized Agent Signature Date (Revised 9/23/2016) <br /> --�— � � <br />