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P�RI�iIT�,PPLICATIOf� <br /> �lD9LDING / PI�ECHANIC�4L/ �LllfVi�IP�1� / SICN / SPRIN��E�/ D�f�iOLll"ION <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 /> c�i�e o�- �i��� s�,� ��,By �'e�se) �����c�r s'�r� A�a���nn�-e'�r� <br /> PROJECT SITE ADDRESS: j O O�- ��•�'�.�-�c:` ��;,-- PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> COId't'�iG"r INF'ORMA'T'101V <br /> OWNER NAME: ��,.'i�•„�,� • �.� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReEr (�(S ��, c:.c'_�;.�, 4.f, �, <br /> -, <br /> GITY �' STA�i�E G.�/��, LIP Z�� <br /> OWNER PHONE: Z. r� (; ` C� �P� ` .S �v OWNER EMAIL: �i �, � �C'�� C � / G��'<'� - �,�1�. <br /> CONTRACTOR NAME: i <br /> CONTRACTOR ADDRESS: sTReer <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 Specify) <br /> CONTACT NAME: CONTACT PHONE: Z, � C, �S� — � �(; <br /> _ , <br /> ��-� t:,:�;�-c'� �,clL ��� � CONTACT EMAIL: C� , •1,> G, �� ��i �: I � G ,� (� - :�� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: �.,,,,,, .�. Contract Price of Work: $ ,��d�.. l' <br /> Proposed Use of Building: —� �-�,,.,.. �_ Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industriai <br /> Type of Project: ❑New ❑Addition emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �T �'_6//l(4, C.��'_ �6^''f' <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 Fixtures #of Lisi of Fixfures #°f List of Fixtures �°f Lisi of Fixtures <br /> Fixtures Fi�ctures Fixfures 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 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/SUPPftESS1AN 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 Official before being authorized under any circumstance.I am the owner,or I am authorized by tire owner of this prope�ty 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 /> PERMIT <br /> �,��� 4���`� �/�/�� I�10� - � � <br /> Owner/Authorized Agent Signature ate (Revrsed 9/23/2016) <br />