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�f���i�l� AC���9Cf��'�� <br /> ��9o�.DOi�C9 / f�i�CHd�f�lICAL/ �L�J��1�9� /SOC��9 / �P�OV�F��E�/ D�iVIOL9�EOP� <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 o� �sa�� s��o�ay �'����� �r����c�se�r� s�����w�s�� <br /> PROJECT SITE ADDRESS: �-2/:,I�J /�1, �IC� PFZOPERTY TAX#:t��l;a 5�1 j 7G0 (L L7(� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �OWTAC`i' iP�FOltt1/d/1l'906N <br /> OWNER NAME: i ����J ��/��/(�JS TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: siREET ��j �-2iQ.f� � V� . <br /> arv �VC sTnTE ✓�1 ziP � G � I <br /> OWNER PHONE: � -����J- ���� OWNER EMAIL: P-��'-! ��6��-�c�M�(L _('�'�I1� <br /> CONTRACTOR NAME: , S(- ,� ('(����J/�TIDJJ S�F_� (��- �� � S <br /> CONTRACTORADDRESS: sTREEr 7c� I 7 -•'�� `__�� _�� <br /> CITY J/V� 6(�(S�"� STATE �,�A ZIP��6L,. <br /> CONTRACTOR PHONE: �L � _ t-P�- �C�'�`.J CONTRACTOR EMAIL: L62Y E� ��5 C 1AL_!5T _C'O.^/1� <br /> CONTRACTOR LICENSE#(REQUIRED): � f- DU�"' S � �f T� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED :�r �I.0��3 <br /> PRIMARY CONTACT: ❑ OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: COIdTACT PHONE: Lf` ` <br /> �, I � � " � '-� -� C�7�' <br /> �J ri?� �✓i /`� n C�./V CONTACT EMAIL: ���-.� �/�-J �F� I+<,'L.l S�5 .��I�i/� <br /> F �`— <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: � "'/'N,(f;� �-(��l�� Contract Price of Work:$ �f� ���t�� '�� <br /> Proposed Use of Building: C F-(!a_�X'�E' Heat Source: �Gas ❑Electric ❑Other <br /> Building Type: �jSFR-Detached ❑SFR-Attached ❑Dupiex ❑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: �1 rT Fbv�C� /.�T (C'IJ � ��� ��C�S W K E�� (T'S �G� ��I�� <br /> GV E � T�M�E" . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT�►PPLl�ATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f Lisf of Fixtures #°f Lisi of Fixtures #°f List of Fixtures <br /> Fixfures Fixtures Fixtures Fixtures <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 Fioor 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 /> SPtt19VKLEi2/SUPPRESSlON SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained lierein is true and correct. Work done pursuant to tiris 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 Official before being authorized under any circumstance. I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> `�" L � (� � �� 7 PER # �I � � �\ S <br /> v <br /> Owner/Authorized Agent Sign ure Date (Revised 9/23/2096) <br /> � � L <br />