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����ni��,���ac��ric <br /> �IJIL.DINC / �l9�CH,4tJIC,4L/ PLIJ�Ii�I�IG /SICf� / SPR9��LER/ ��f�iOLITION <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 /> (eo�e or i�ia�� a�,� o�sy �oe�s�) ��o���� �or� a��o�n��T'o� <br /> PROJECT SITE ADDRESS: Z � �"�. �1d}-j� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTAC`Y' IPIFORMATION <br /> OWNER NAME: Gj/1�J/1 /j! l �� � TENANT NAME(If Gommercial): <br /> OWNER MAILING ADDRESS: sTREET � � � � <br /> CITY !�j��� STATE � ZIP � �ZO <br /> OWNER PHONE: �G� ' � - Z OWNER EMAIL: /�jf- ,�� , �jTJjl�!( � ,(�. (�,�Fr <br /> CONTRACTOR NAME: DG�O G \ <br /> CONTRACTOR ADDRESS: � srREEr '�-f•Z ,/Ji7 �• �/ � <br /> CITY 7�L�(Lr/ STATE i��" ZIP �� <br /> CONTRACTOR PHONE: �a�- � - (o ��f� CONTRACTOR EMAIL: 6� cZD �' G, C=p <br /> CONTRACTOR LICENSE#(REQUIRED���G �J CITY OF EVERETT BUSINESS LICENSE#(REQUI D): Z' <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ❑ OTHER(Please Specify) � � � � <br /> CONTACT NAME: CONTACT PHONE: � ��. G� _ �'�'1� � <br /> �� JL� G��J CONTACT EMAIL: �D�U�� � ✓��C� Lv�v� <br /> BUILDING 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 /> ���itq-C-� G'�1� ��i�r/�'lG- DlG l+/'�9��� r�,ro��r'K- � i�v5t�3t1 (�TiJ��' Vt,�'�, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLI��TION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixfures #�f List of Fixfures #°f List of Fixfures #of Lisf of Fixtures <br /> Fixiures Fi�ctures Fixtures Fixiures <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 /> SPRIINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDC-'EMENT: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 /> cu�rent federal,.stafe,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must frrst 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 pertorm the work for which application is made, <br /> and 1 comply with the State rs Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Offrcial Use Only <br /> ���� / PERMIT# � �� <br /> /�;%%/� �/1����/� � � <br /> Owner/Au otfi'r�z d Agent Signature Date (Revised 9/23/2016) <br /> � <br />