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����i�r aa����c�,�io� <br /> �uo��ar�� i m�c�a,��ic��� ��.u��i�� � si�� �s��i������ ���noLirio� <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� wwvd.everettwa.gov/permits <br /> (Blue or �lack !nk �nly �lease) �R�JEC7' SIYE INF�RNiAT18F� <br /> PROJECT SITE ADDRESS: �`� ,� �V�� �L� �!�'7a` PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> �OMTAC'r It�1FOf2MAT10N <br /> �- <br /> OWNER NAME: ,���� � ./V�E � �/-� �J TENANT NAME(If Commercial); 'W r.�'� �� <br /> OWNERMAILINGADDRESS: srREEr jLj ZG i�J �AI!� ('7 '�� �Vi�•l �C� <br /> CITY �� y�j" '� STATE V�V ' ` ZIP �, � <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME h'�U 1 1�1 � � �C:UN� � S <br /> CONTRACTOR ADDRESS: srReeT �� �M � i '�� <br /> CITY �v�'��j STATE ZIP � � <br /> CONTRACTOR PHONE: �J 'j' y�j' �� l CONTRACTOR EMAIL:�„/�i "' ' Z�j+f�,/�`( l,l:�p}tC-1U1LS)�t�ilf � r <br /> .��,vl, <br /> CONTRACTOR LICENSE#(REQUIRED): �� -' ' j.�. � .� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): � '�G�� <br /> PRIMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: r� �. � n ,� l CONTACT PHONE: f�'Z�j, l��e � ,�-�y <br /> �7 L� �r1��' _ � <br /> coNTac-r Emai�: �. ��,'��?�"�.C�i1� -� tii�cC�S.ti�:����-t2✓� .�as+� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: '� � (� Contract Price of Work:$ ,,�Jv � <br /> i <br /> Proposed Use of Building: �:���1 � Heat Source: ❑Gas �Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �6ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> � �71�Z—�--� ��i'�=��„7 (1'�'�--lv i!�J�� ,�l�i� �N'11..i�w O!.1 � �v'� �-t U\�. <br /> �,�! �YL.f_. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PEEtMiT APPLICATION PLUMBIf�YG PERMIT APPLI�ATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixfures #of Lisf of Fi�ures #�f List of Fixtures #°f List of Fixtures <br /> Fixfures Fi�ctures 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/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SY�TEM <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,sfate,and loca!law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be authorized in writing from the <br /> Building Offrcial before being authorized under any crrcumstance.l am the owner,or l am authorized by the owner of this property to pertorm the work for which application rs made, <br /> and I comply with the State Confractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Otficial Use Only <br /> ��"� �VI� (i`� 1� PERMIT l���f ��c./ <br /> Owner/Authonzed Agent ignature Date (Revised 9/23/2016) <br /> � <br /> /L- <br />