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i <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLfTION <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetfeps@everet[wa.gov� www.everettwa.gov/permits <br /> PFtOJECT$ITE INF0�2MATlOtd <br /> _ _. - : <br /> PROJEC7 SITE ADQRE S: PROPERTY TAX#: : <br /> 7 u.�_1��_�.���e L✓I� i <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) � <br /> � <br /> 'CONTACT INFORMATION' ! <br /> OWNER NAME: � � p J� TENANT NAME((f Commercial); S �v�� � <br /> OWNER MAiLING ADDRESS: sTReFT � � � � 1(;J�-� S�, <br /> � <br /> C�7y C � N n�'�-1 STATE (}r�'� ZIP '7 ,S � f S <br /> OWNER PHONE: OWNER EMAIL: <br /> _ _ _ _ _ <br /> CONTRACTOR NAME: JU , , _. _ '_ L�G ��`r.✓ ' _ _ ` - ' ; � <br /> �lJ l rv1, c. � ., CL 5 � �:� -i ,..� _ i -'.c, ;: <br /> CONTRACTOR ADDRESS: sTReer Z Z� � 7 z�{ �`�' �j , S �"— C/G � <br /> ciTv � srnre ziP C l�J � Z— I <br /> CONTRACTOR PHONE: Z - z - 7 CONTRACTOR EMAIL: + <br /> CONTRACTOR LICENSE#(REQUIRED): CG C�- �- �WM `{C ICL C1TY OF EVERETT BUSINESS LICENSE#(REQUIRED): � j <br /> _ _. _ _... _. _. _ _ � <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR ❑OTHER(Please Specify) ' � !�i! ' i✓ �I� '. <br /> CONTACT NAME: CONTACT PHONE:- � _ �'c - D�O ' <br /> � i <br /> I �t � .� '� CONTACT EMAIL: ^' �'��^^'��Ct?°� - ' �� I <br /> i <br /> � BUILDING PERMIT APPLICATION � <br /> =; ; ,_ � , i <br /> Existing Use of Building: �G✓i� Contract Price of Work:$ cpC%� L�C`��. �` ; <br /> Proposed Use of Building: ���,� Heat Source: ❑Gas ❑Elecfric ❑Other � <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�k of Units: ommercial ❑Industrial � <br /> Type of Project: ❑New C7Addition ❑Remodel �Repair ❑T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ! <br /> j�c�� �ar�' e�crs�� �e r-���F- w� l�� '7"Pv S�►�SI Q j� �� r�:F r��br��� s�s�`� � � <br /> `,,S `� P�j(�ilS� r+iSv li_�Iv,�, � r� ?'� � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ✓ <br /> _ __ _ _ _ ,_ __ _ .:_: � <br /> ='_MEGHANICAL PERMIT APPLICATION PLUMBING_PERMIT APPLICATIOf�i ` " ` <br /> _- -. __ __ : = ; <br /> Type of Project: _New _ Addn _Alterafion _Repair Type of Project: _New _Addn Alteration _Repair � <br /> #of List of Fixtures ��f List of Fixtures �°f List of Fixtures #of List of Fixtures <br /> Fi�ures Fixtures Fixfures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) _ <br /> Forced Air Systems iJnit Heater Bathtub Urinal � <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain � <br /> N <br /> Water Heafer Refrigerafion Shower Floor Drain <br /> Gas Fireplace Wood Stove Kifchen 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. j, <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: ! <br /> ' SPRINKLER`!SUPPRESSION SYSYEM_ '` <br /> _: . _ _.-- _ . _ _ <br /> Number of Heads ' <br /> ,.. <br /> i <br /> ACKNOWLEDGEMEN7`I have reviewed ihis applicafion and confirm the information confained herein is true and correct.Work done pursuanf to fhis permif must comply with <br /> current federal,state,and loca/law.The granfing of a permit onty authorizes approved v✓ork and no deviations theref�om.Deviations must frrst be auihorized in writing from the <br /> Building Olficial before 6eing authorized under any circumstance.I am the owner,or I am authorized by tlie ovmer of this property to perform the work for which application is made, �; <br /> and f comply with fhe Stafe Cont�actors Law 18.27 RCW nd 296.200Fl WAC. <br /> �� City ofEvereff Official Use Only r <br /> � �� � PERMIT# ','.; <br /> Z" ��i i ! _. �� � ; <br /> _ -��� t ! <br /> OwnedAufhorized Agent Signature Date (Revised 90/7212095) � "� <br /> � 1 �� <br /> ,� <br /> � �;. <br />