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III'I' PERMIT APPLICATI� <br /> BUILD�MIIJ/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 <br /> �glu���tll`�,�l��I�1���i`�h1YY.���S±�) "�, ��P�R�Q"�,E`C,rT�S1TEINF=O�'lli��i"I�N��`"= aT''v�,� �ik���.i�an,���.��r. ur� ' ,. '.��; <br /> PROJECT SITE ADDRESS: 1 a 5- E �'1T PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> ���-r� i�u�i. � � �,r yr.,i �. S i a. r �IL�I��IIFt"-�'�68�q � 4 '�`+, z � nu�t. <br /> . � �, �:�a ' °CONT,�, T��MF� M��tt'�N�,� � ��� ���a���_� ��nG��� �,3 ' � <br /> � ��i ��„u i� a 4_ � , �ti ,fi. <br /> OWNER NAME: f�(�,� � � $S(j�l�� TENANT NAME(If Commercial): � ��� �� ��r � <br /> OWNER MAILING ADDRESS: srReer W <br /> cirv �", STATE ZIP 9 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; � S ��.e r j�'� <br /> CONTRACTOR ADDRESS: srReer � ��- � Q <br /> ciTv � I STATE -� ziP <br /> CONTRACTOR PHONE: �'j- �� �t..��JU CONTRACTOR EMAIL: � �j ��, r Cp�'j') <br /> CONTRACTOR LICENSE#(REQUIRED): � �r"j � 'r'J (� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED (p��p <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ��F� �t75� "/`'�'DU <br /> �►�r� s�C�j�U,r r CONTACT EMAIL: j5�- � �, <br /> - - �`` 'BUILDING PERMIT 4►�PLI�A'�ION � <br /> Existin Use of Buildin : �� Contract Price of Wor .$ Q ��� • a <br /> Proposed Use of Buildin : -�(� � Heat Source: ❑Ga ❑Electric ❑Oth <br /> Buildin T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: Co ercial ❑Industrial <br /> T pe of Pro'ect: ❑New ❑Addition ['jRemodel ❑Re air T.I. ❑Si n ❑Sprinkier ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> �rla n-f- �n'J p rv�/..QI��t-f- �r /`!� r��9-�i <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> k��r' ���.M�`c�,. ���i�" � R°n"nr{;�p:.;P��c�,tN�i�r {.� , ��:uMB �r�r�►���'�l�1����'p, '�' �T�Q'���� �. :'w , ,�;.,�; <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fi�ures Fixfures Fixtures <br /> A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato Wash Basin Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes D er Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other: <br /> A• SpRINKLEI�tSUPPRESSION°SYSTEM' ."` <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and con�rm the information contained herein is true and correct.Work done pursuant to this permit must comp/y with <br /> current federal,state,and/oca/law. The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�cial before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and/comply with the State Contra tors Law 18.27 RCW and 296.200A WAC. <br /> . <br /> City of Everett Official Use On/y <br /> PE # � <br /> � � � <br /> ner/Authorized Agent Sign re Date (Revised 9/23/2016) <br /> G <br />