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������-����ic,��ao <br /> ��i��a�� � ��c��a�Ac��i ��u��o�� � sic� � ���e�v���� � ���no���rio� <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 /> Q�la�e �� �S���S 6o��a�re9y �ie��e� �E���A���'S6`P� 9�F��B19a�1�90� <br /> PROJECT SITE ADDRESS: G�,5 L� l,� f�Tv;� y\t,�;; PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �Ota1T�C�' INFOEtIifd�4T009� <br /> OWNER NAME: y'vt L �,�� y�� �'j�a�:N✓ TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: sTReer (� ` E; � �'' <br /> CITY � ��, STATE �!l ZIP � G��"�,' <br /> OWNER PHONE: ?7 r - V OWNER EMAIL: <br /> CONTRACTOR NAME: k��j Y�WA {� �- <br /> CONTRACTOR ADDRESS: sTREeT 2\'Z p , !�E l" <br /> CITY ���^�� STATE ���/�'�- ZIP ��L� 'G.(;.r <br /> CONTRACTOR PHONE: ' ..'Z Z-2j 11 L CONTRACTOR EMAIL: l�l(%a v-� '4> C ��-/k,ix v\ �� <br /> CONTRACTOR LICENSE#(REQUIRED): ►:, 5'jp.��,��1 •��'� -�l; " CITY OF EVERETT BUSINESS LICENSE#(RE IRE � <br /> PRIMARY CONTACT: ❑OWNER C�'CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: COfJTACT PHONE: �{'Zij_�yZ_-z��p,� <br /> (�i+--�U�-Ci-- �� ?'v"'- CONTACT EMAIL: rvL��;f?,�;(,. � ��°y�bt.� <br /> BUILDINYG PERMI'��1PPLICATIOFI <br /> Existing Use of Building: Contract Price of Work:$ � �'i.�{ �U <br /> Proposed Use of Building: Heat Source: [�Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached C�SISFR-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: ,\�,�i f�� .Z �` –�� 1,� �,'r�N�= J..-�%rLN3•'�v� <br /> r� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PEl2MIT APPLICATION PLUMBING PERMIT APPLl�ATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisf of Fixtures #�f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixfures Fixtures 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/SUPPRESSIOfd SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:1 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 autliorizes approved work and no deviations therefrom.Deviations musf first be aufhorized in writing from the <br /> Building Official before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> _ City of Everett Official Use Only <br /> � , \�� .� P�T��C�� — <br /> Owner/Authorized Agemt S� nature Date (Revised 9/23/2016) <br /> E <br />