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��R1�19�A���9CATI0� <br /> �U9LDIi�G / iViECFiANICA�/ PLU��IRIG / SIGR� 1 �PR16��LER/ DE�VIOLGTION <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 /> ��t�e or �aac�s a��o�oy�i����) ������� sa�� '�F�����so� <br /> PROJECT SITE ADDRESS: � � ��- ��lJ - G�L%VI -���✓U' � PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> COFvIT/4C�' If�FOE21V1A'f90�+! <br /> OWNER NAME: L.�/�--- (`j 5(GA��L-- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer O Z � L/€✓� UFi1U <br /> CITY ��i/[,7[� STATE LIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; �G n---��"' � <br /> �-R�sg>:d.� <br /> CONTRACTOR ADDRESS: sTREeT <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: Lf-'L — 7j— `-"]OSS CONTRACTOR EMAIL: fZ� � 'F,� Q �C(.1� 1� . C.0 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 3�,0.— �Z_-2 Z� � <br /> �L ���2 CONTACT EMAIL: y LU2�� [��/J �� /¢��lJ�. CC�It'j <br /> BUILDINC PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ �� � <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> N F�.�-t �4�X l4� D�c�(�. <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLI�ATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fi�ctures #�f List of Fixtures #°f Lisi of Fixtures #°f Lisf of Fixtures <br /> Fi�ctures Fixfures 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 /> SPRIlVKLER/SUPPRESSION SYSTEM <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,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 Off' al before being authorized under any circumstance. I am the owner,or l am authorized by the owner of this property to perform the work for which applicatron is rnade, <br /> and l com ly ith he State Con ctors Law 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> G U �� ��� PERMIT� �-`�;I �•<, � ��� <br /> �, <br /> Owne/ ho�zed Agent Signature 1 Date (Revised 9/23/2016) <br /> ;: � <br /> lz <br />