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P��iiVll7',�PPLICATION <br /> BUILDII'"' ` �ilEC�iARIICAL/ PLUnli�ING /SIG .>PRIft�KLER/ DEiVlC)L.ITION <br /> C1TY OF EVERETT PERMIT SER�.. ,_ <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 � (E)everetteps@everetiwa.gov� www.everettwa.gov/permifs <br /> :_. <br /> „ _ <br /> PROJECT SITE IAIFORMa4710N= - _ :. ` <br /> PROJECT SITE ADDRESS: �? � PROPERTY TAX#: <br /> J <br /> LEGAL for new construction: Short PlafJsubdivision Lot No. (atfach copy of long fegal description) <br /> ' - CONTA,CT 1(dFOitMAi'IOId <br /> OWNER NAME: '��� � " i, "�, G��- -� TENANT NAME(If Commercial): <br /> �, <br /> OWNER MAILING ADDRESS: srREET .�C)Grh J�� <br /> � '�G( � CITY STATE ��C�(�� ZIP <br /> OWNERPHONE: ' ���j-15ZS � OWNEREMAIL � ,SGLC LE�y��l�`�z--' i`a� C <br /> CONTRACTOR NAME; <br /> CONTRACTOR ADDRESS: sTReET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER(Please 5pecify) <br /> CONTACT NAME: CONTAC7 PHONE: <br /> CONTACT EMAIL: <br /> , , _ . _ . . _. .. <br /> BUILDING PERMIT APP.LICATION <br /> F�isting llse of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Defached ❑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 /> `1��Gt L�' ���1�I,�.1�,�: c�� � I I�'� �'1� � � �M�� <br /> ASSOCIATED BUILDING PERMIT#(ifi applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION '.; <br /> Type of Project: _New _ Addn _Alferation _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of Lisf of Fixtures #�f Lisf of Fixfures #�f Lisf of Fixfures #°f List of Fixtures <br /> Fixfures Fixtures Fixfures Fi fures <br /> A/C—Air Handling Unifs Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systerns Unit Heater 3 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: z Clothes Washer Medical Gas <br /> Range Hood �' Water Heater Other: <br /> Exhaust Fan / Sink(Service/Bar/Mop/etc.) Ofher: <br /> SPRINKLER/SUPPRESSIOPd SYSTEM ,� <br /> Number of Heads <br /> ACKNOfNLEDGEMENT.�1 have reviewed this application and confirm the inforrnafion contained herein is tnre and correct. Work done pursuanf fo this permit must comply with <br /> cu�renf federal,state,and loca!IawyThe g nting of a permif only authorizes app�oved work and no deviations therefrom.Deviations must first be authonzed in writing from the <br /> Building O�cial before being autf�io�ized der a rcumsfance.I am the owner,or l am autho�zed by the owner of this property to perform fhe wo�k for which application is made, <br /> and/comply with the State Contracto Law 9g RCW and 296.200A WAC. <br /> Cify of Everett Official Use Only <br /> � %' ' PERMIT# � <br /> / � O y � 4� <br /> �,;� � �� �?� �l � <br /> Ow er utho ized A nfSign re ate (Revised 90/12/2095) <br /> % C <br />