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'' I 'I PERMIT APPLICATIO
<br /> BUILDIN(a 1�IECHANICAL/PLUMBING/SIGN�INKLER/DEMOLITION
<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
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<br /> �Blue:�r Black I�iir Or�ly:�I�se) , ,Y� �.���Q.�ECT�f�E INFORII�A�161�(.,�. �,. '�,�<�r u. ��;�����,r �`";.
<br /> PROJECT SITE ADDRESS:( •(�QL r, V � C1 q ZQ PROPERTY TAX#: O(o -`� 00(�O O
<br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legai description)
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<br /> ,_., - CQ1!ITACT'INFORM�T�O�1 ` �
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<br /> OWNER NAME:M�k � ��vu LK ��� '�,(�TENANT NAME(if Commercial): pJ Q.'t uha l'I�n
<br /> OWNER MAILING ADDRESS: srr:eeT
<br /> CITY STATE ZIP
<br /> OWNERPHONE: 'ZO(o-��jq �'�O OWNEREMAIL: ���,�4,`� „_Me�e,r ho�" l�• C
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<br /> CONTRACTOR NAME: �,�,K C C v C c,.v I�
<br /> CONTRACTOR ADDRESS: srneeT � E a t�r� � Wu.�
<br /> � S CITY A STATE ZIP O Z�
<br /> CONTRACTOR PHONE: �{2S� ' . 3(o CONTRACTOR EMAIL: A�/e L' hp�+l'Mu,�C. LO
<br /> CONTRACTOR LICENSE#(REQUIRED):�(�IE R G l N U CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O2 S�OCe
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<br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: 'QavC p�p�� CONTACT PHONE: l.�Z 7 7�D �
<br /> G1flt.�'M CohS^�t'uLT1or CONTACT EMAIL: �vG ��{��• LO
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<br /> Existing Use of Building: - ee�t G Contract Price of Work:$ O 0 �/'
<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 Pro'ect: ❑New ❑Addition ❑Remodel Re air ❑T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTIONOFWORK: _m�nO�I"_ b�►��c��'n t' C�t.�'�'S �O StcA.�t�
<br /> � � y w►�aow: d�yw�c
<br /> _W_u.l.l due '� ve.h�cle. �urn�►c�. _ _$ee _a. 1�c.c�.t�SL � vu lv�...-�o�n 1 I t 6I��S
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ,., �IiIECHANI,�AL?rPE',.: _�ITx�PL1CA'�1'�Q1�" ,.... ;'' ,..� ._. " 3
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<br /> of Project: _New Addn Alteration _Repair Type of Project: _New _Addn Alteration _Repair
<br /> Fixtures �jst of Fiutures Fixtu es List of Fixtures Fiartures List of Fixtures Fixtures List of Fiartures
<br /> Air Handling Units Heat Pump Toilet Backflow Preventer Inside Bldg
<br /> Force 'r Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash in) Drinking F in
<br /> Water Heater Refrigeration Shower Floor Dr
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease
<br /> Range Ducting Dishwasher Roof D ains
<br /> hes Dryer Hookups Other: Clothes Washer dical Gas
<br /> nge Hood Water Heater Othe .
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> 3PRINKLER%SUPPRES,SiON.SYS'�"... ' ,,
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information confained herein is true and correct Work done pursuant to fhis permk 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�cia/before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,
<br /> and i comp �t e State Contrac Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett O�cial Use On/y
<br /> PERMIT
<br /> � 3� l $O f - 0 ��
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) -
<br /> ��.
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