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�IE�B�iB�'6�V��LBC�AT90P� <br /> �199LD9i�C� / �ViECHARlICP+L/ �LU6�i�INC /SACCh� / SP�6flI�i�ER/ D��IJ10L9T90� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8H57 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> ��iue o� �ea�� a�a���ay �ie���� ������r s'r� '�����n����� <br /> PROJECT SITE ADDRESS: 2 -�}-i��.`; S� ��� _(,+�r�' �'���C I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CON7'AC'r' I�e9FORIVdAT90P➢ <br /> OWNER NAME: '�r�-��5�� �`�T� TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srREEr • ��-'t�� �S� <br /> CIN � �V�ti' 1 STATE ��+.I� ZIP �<�� <br /> OWNER PHONE: c�_j � j — �� OWNER EMAIL: <br /> CONTRACTOR NAME; Q����-�L_ ��S 1 �"�-L_ <br /> CONTRACTORADDRESS: srRE�r <br /> ciTv sTnTE 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: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICAYI <br /> Existing Use of Building: Contract Price of : $ <br /> Proposed Use of Building: Heat Source: Gas lectric ❑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: m � <br /> U V�� "�{�} s fi--`j 2���� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PElZMIT APPLICATION PLUMBING PERMIT APPLlGATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of List of Fixtures #�f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fi�cfures 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(ServicelBar/Mop/etc.) Other: <br /> SPRI�IKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contarned 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 befo�e being autliorized under any circumstance.l am the owner, or I am authorrzed by the owner of this property to perform the work for which application is made, <br /> and l comply with the St Contractors Law 18.?7 RCW and 296.200A WAC. <br /> City of Everett Offfcial Use Only <br /> PERM T# <br /> ��-- °I I — �-3�_ I �- — <br /> Owner/A� t Signature Date (Revised 9/23/20 6) <br />