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PERf�Ifl"APPLIC�4`f(C.. <br /> �U1LD__._ I�Iii�GHAMVIC+�[�/ F'LU�f161RIG I SIGP�. L;�RI�iKL.ER/ D�i11101�17'I(alt! <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 GEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-881 D � FAX 425-257-8857 �(E)evereiteps@everettwa.gov� www.everettwa.gov/permits � <br /> (�lue or�Iacl4 St�fx Only�lease) 6a88�.➢I�CY S!'Y�16�l��Rfll��a'�'l�f� <br /> PROJECT SITE ADDRESS: � ��`�``�( `�r�''7���,���` ;/ l PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision � Lot No. (aftach copy of long legal description) <br /> ° � C��i'Y°A�'Y' 71�gO�A'I'IOP9 . <br /> OWNER NAME: � �,����� " %�� � TENANT 1VAME(If Commercial):��r,�� /.��'(j, � �*�j ��jt <br /> OWNER MAILING AQDRESS: sTtzeEr �fS� ,� � C� � �� � `�� <br /> � � rc�'� t. � '� �� ' STATE ��' ZIP � .�f � � <br /> OW[VER PHONE: � (�' "��Cs '"'� � ��'� OWNER EMAIL: `�(�'''� ' ,: � j J -� i ��`YJ' i�E G'C'l <br /> CONTRACTOR NAME: ,����1G� �' , � .L -6',;•:�-a�e�. �'l r� Z C, v�rw.�/.4G�j <br /> CONTRACTOR ADDRESS: � s�EEr I " ��� �� � ` � <br /> CITY 'C� f^� � 'V 1�(��, � STATE ° ZIP <br /> CONTRACTOR PHONE: � ' {�j � CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT SUSINESS LICENSE#(REf1UIRED): " <br /> PRIMARY CONTAC7�OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: ������ �I�����P,� CONTACT PHONE: <br /> • CONTACT EMAIL: . <br /> BUILDING PERMIT APPLICATION <br /> E�cisting Use of Building: �,��� � Contract Price of Work:$ � C�+ <br /> Proposed Use of Building:`f� C`_("'J ;/V Heat Source: ❑Gas �lElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑5FR-Attached ❑Duplex ❑Muffi-Family-#of Unifs: ❑Commercial ❑Industrial <br /> Type of Project: ❑Ne�nr �Addifion ❑Remodel ❑Repair ❑T.I. �ISign ❑Sprinkler �7Demolition ❑Change of Use <br /> DESCRIPTION OF VI(ORK- <br /> ,,'..� � ��'�1�/� 1��� �' C COG'3 �z������i,x/�' -f`' ��11a�� G.r/�/l-Y�,/i� <br /> , � <br /> 'c I/ ,f { <br /> 1���� - 1�G��'"��iia� c' Cfl/1rt�c�l�/G �'�G� F''I'�'C' C'� ,� �:� . <br /> ASSOCIATED�UILDING PERM�T#(if�plic�abl� ��'7�����f J/Y��'f' � �// N�� / - <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #�f List of Fixtures #of List of Ffxtures #°f List of Frxfure�/ <br /> Fixtures Fixtures Fixfures Fixtures <br /> A/C—Air Handling Units ,Weat Pump f Toilet Backflow Preuenter(Inside Bldg) <br /> Forced Air Systems nit Heater Bathfub / Urinal `..� ' <br /> Gas Pipmg Boiler• F Lavatory(Wash Basin) D inkia�g"Founfain <br /> Water Heater `� Refirigeration Shower ,5' F oor Drain <br /> Gas Fireplace Wood Sfove Kifchen Sink&Disposal �- Grease Trap <br /> ,�_Gas Range Ducting Dishwasher '�"� Roof Drains <br /> Clothes Drye� ooKups Other: Clothes Washer _ � �) ' Medical Gas <br /> Range-N6�d Water Heater Other: <br /> Exhaust�an Sink(Service/Bar/Mop/efc.) Other: <br /> � SPR�AI4CLER/SUPPRESSIOId SYSTEM . <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT.�1 have reviewed this application and conffrm the information contained herein is true and correct.Work done pursuant to this permit must comp/y with <br /> current federal,state,and loca!law. The granting of a permif only authorizes approved work and no devrations fherefrom.Deviations must firsf be authorized in writing from the <br /> Building O�cial before being autho"zed under any circumsfance.l am fhe owner,or I am authorized by the owner of this properfy to perform the work for which application is made, <br /> and I co ,y 'h the State r..,�t s���.aw 9827 RCW and 296.200A WAC. <br /> Cify of Everett Officiai Use Only <br /> - _ PERMIT# � � <br /> — �,(f — fa �f'j i�, �1 :/'�'� %: <br /> 4✓ er/'Authonz • tgnature Date (Revised 9/23/2016) <br /> /` <br />