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PERMIT APPLICATIC: . <br />BUILDIN IIECHANICAL / PLUMBING / SIGI� ��PRINKLER / DEMOLITION <br />CITY OF EVERETT �ERMIT 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 />PROJECT SI'rE INF�RMATION <br />P('iOJECT SITE ADDRESS: �3i5 C��� �` PROPERTY TAX #: OD������lO2�D� <br />LF_GAL for �ew construction: Short PlaUsubdivisiorl�AU/t7%L,�.� /lj�/�LS �/(%�ot No. 7i (attach copy of long legal description) <br />CONTACT INFORMATION <br />OWNER NAME: !�G/f� 1%/(9S 2� G(� TENANT NAIVIE (If Commercial): <br />OWNER MAILING ADDRESS: srrzEer /Z3D % /U� %T �y �/� %��% ,� <br />CITY ���G �L�/(i� STATE `/✓TI <br />OWNER PHONE: �`lp- %�� 3/ Z3 OWNER EMAIL: /y� �� ��/ �f <br />GLiNTRACTOR NAME; <br />��, <br />CD,v�72�7/d/U Co,vsUG %/�LG� C!� <br />CONTRACTOR ADDRESS: sTReeT ��22 /�5 7�>9u� iU/� <br />v ��TY ,�/2kG�r <br />CC)NTRACTOR PHONE: �lyy��-- 992� <br />��C)NTRACTOR LICENSE #(REqUIRED): �OGC� CC <br />r'F',IiVIARY CONTACT: ❑ OWNER ❑ CONTRACTOR <br />C(7M7ACT NAME: • <br />W« � itJ�`� Go ?7� i�,� <br />STATE <br />ziP 9, <br />ZIP <br />CONTRACTOR EMAI�: r/l((Q'/j'jqq'�'�pj� Cj f <br />G� CITY OF EVERETT BUSINESS LICENSE #(REQUI <br />"HER (Please Specify) J,��/6�1z'2� <br />♦fdONTACT PHOfVE� 2�1p - �jSZ_ �2� � (�,�.�� <br />CONTACT EMAIL: Gjj/n�Q�l��,��� Cj��/J�, <br />�3 <br />BUILDING PERMIT APPLICATION <br />cxisting Use of Building: �%�R�j/'L � C�2 Contract Price of Work: $�¢j ��� <br />Proposed Use of Building: G/QZf�G�L �— �/� Heat Source: ❑Gas ❑Electr'rc ❑Other <br />Building Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-# of Units: ❑Commercial ❑Industrial <br />Type of Project: ❑New ❑Addition ❑Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br />C�ESCRIPTION OF WORK: _ �.f'_�v��� �-��S���G � �� �/2 SG ��2RG� <br />e�,�S�iCiATED BU9LDING PERMIT # (if applicablel: <br />MECHAIdICAL PERMIT APPI.ICATION <br />T��pe of Project: _New _ Addn _Alteration _F2epair <br />Fi.tures List of Fixtures Fixtures List of Fixdures <br />a A/C — Air Handlin Units Heat Pump <br />Forced Air Systems Unit Heater� <br />� Gas Piping Boiler <br />Water Heater <br />� Gas Fireplace <br />~ Gas Range <br />Clothes Dryer Hooku <br />Range Hood <br />� � Exhaust Fan <br />rtetngerat�on <br />Wood Stove <br />PLtl�MBING FERMIT APPLIGATION <br />Type of Project: _New ^Addn _Alteration _Repair <br /># oi List uf Fixtures # of List of Fixtures <br />Fixtures Fixtures <br />Toilet Backflow Preventer (Inside Bld <br />Rathtub Urinal <br />Lavatory {Wash Basin) Drinking Fountain <br />Shower Floor Drain <br />Kitchen Sink & Disposai Grease Trap <br />Dishwasher Roof Drains <br />Clothes Washer Medical Gas <br />1Nater Heater Other: <br />Sink Service/�3ar/Mop/etc.) Other: <br />SPRINIiCLER / SUPPRES�ION 3YSTEM <br />�� Number of Heads <br />,1Ci(�'OWLEDGEMENT: I have reviewed this application and cor,firm the information contained !ierein is true and correct. Work done pursuant to this permit must comply with <br />r,�urent iederal, state, and local law. The granting of a permit only authorires approved worlc anc' no deviations lheref�om. Deviatrons must first be authorized in writiny from th2 <br />13uildiny Official efore being authorized under any circumstance. ! am the owner; cr i an� authorized by the o,a�ner of thrs prop.:rty to perform the work for which application is made, <br />,vrid ! comply ith the Stat ontractors Law i8.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT <br />..._.__ ��� ° �l 6i D� 20�__ , , � � � �� I <br />Ovii�er/authonzed Agent Sognature Dats iREv�sed 10/12/2 15) <br />