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PERMIT APPL.iCATION <br /> BUILDING / MECHANICAL ! PLUMBING !SIGN !SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEQAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8890 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� tiwvw.everettwa.govlpermits <br /> (Blae or Bfack Ink On1y.Please) `:PRO.IEC7 SITE [NFORMATION ` <br /> PROJECT SITE ADDF2ESS: �(�Z5 ✓r.� �en �`� Sp�f ti PROPEiiTY TAX#: 2 S��//3ov/a�7 o v <br /> LEGAL for new construction: Short Platlsubdivision Lot No. (atfach copy ot long legal descriptian) <br /> 'Cf3NTACT IN�ORMATION ' <br /> OWNER NAME: �n^ ✓'��h v , G yJ�r�? S 1LG TENANT NAME{If Commercial): �S <br /> OWNER MAILING ADDRESS: srnee-r y�i✓' YGGi^ W� 5+-�-• 'G �`o V <br /> CI7Y ���/'/�'�i" STATE � ZIP � � <br /> OWNER PHONE: OW R EMAIL: <br /> CONTRACTQR NAME; — <br /> CONTRACTORADDRESS: srREET `, � �J l. �,l = c� C. � C� <br /> CIIY S7ATE ZIP 2, <br /> CONTRACTOR PHONE: �j�Q Z (.p 2 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED)�� .�0 Ql� � CI'CY OF EVERETT BUSINESS LIGENSE#(REQUtR D): � <br /> PRIfNARY CONTACY; OWNER �CONTRAC70R �,QTHER(Please Specify) � � �� -- <br /> CONTAGT NANl�: Gt�''� ��- -�.r '�� CONTACT PHOfVE: �� Z�2 .. 2��aj <br /> 2t3lZa✓��-�►►f,e.G-L1 �'�.,.r CONTACT EMAI�.: ��h iG- !G (��1 ZR✓�hr �G �. ,� <br /> 'BUILDING PERMIT APP4[CATION <br /> Existing Use of Buiiding: Contract Price of Work:$ 70 4v O <br /> F'roposed Use of Building: d li- Heat Source: L�as ❑Electric ❑Other <br /> Building 7ype: ❑SFR-Detach d ❑SFR-Attached ❑Dupiex ❑Mulii-Famil -#of Units: �ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑12emodei �Repair T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTIOfJ OF WORK: /� ��l,�� 1 s. �� � �' p.-1 �,�6rs d �'!0 0 � <br /> /T 7 <br /> df �x�st of�ro � l�lo�� . <br /> ASSOCIA7ED BUlLD1NG PERMiT# if ap licable): <br /> MECHANICAL PERMITAPPLICATION ` `PLUMBING PERMIT APPLICATION ` <br /> Type of Project; New _ Addn Alteration Repair Type of Profect: _New Addn Alteration ____Repair <br /> #of List of Fixtures #of Lisf af Fixtures #�f Llst of Fixtures �°f Llst of Fixtures <br /> Fixtures Frxfures Ffxtures Fixtures <br /> A/C-Air Flandling Units Heat Pump Toilet Backflow Preventer(insfde B1dg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory{Wash Basin} Drinking Fountain <br /> Water Heater Refri eration Shower Floor Orain <br /> Gas Fireplace Wood SEove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Ciothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) O#her: <br /> '`SPRINKLER/$UPPRESSION SYSTEM. '' <br /> Chemical or Water No.of Heads <br /> ACKNOWLEbGEMEN7:f have reviewed thls appfication and confirm the inforrnatian contalned hereln fs true and correcf.Work dona pursuant to thls permit must comply with <br /> current federal,sta[e,and foca!law. The granting of a parmit only authorizes approved work and no deviations therefrom.Deviafions must firsf be eulhorized in writing from the <br /> Building Officia(before being authorized under any circumslance.1 am the owner,or 1 am authorized by tt�e owner otthls property to perfam the work tor whrclz application is made, <br /> and 1 compfy wifh U>e State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everelt Official Use Only <br /> � PERM17# � <br /> �r Z oav .//• �p 7 i� �1 � �3 ';� � :�'" <br /> OwnerlAuthorized A ent Signature Da#e (Revised 9123/2016) / � <br /> / <br /> � <br />