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PERMIT APPLICATIO <br /> BUILDIN•VIECHANICAL/ PLUMBING I SIG RINKLER I DEMOLITION <br /> CITY OF[VE�-REi i PFRMIT S[RVICES g�-S�2 —�'�S <br /> 32C0 C[DAR S1R[G7, EVERETT,WA 9J.'O1 ia --iy i5 <br /> (P).25�257-8810 � FNf�25-257-tld57 �(E)eve�et�eps�eve�eitwa.gov� �wr,vweret��+��govlpvrmas <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE A�DRESS: '3S�O CpI�j AVQ �� PROPERTY TAX#: /UQ (..f� I(� �(�6` O 1'ap' <br /> LEGAL(or new[ons;rucbon ShoR PIaI/suCarvison Lot No_ (attach copy ol long�ega1 descr�pt�on) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(It Commcrciai�: <br /> OWNER MAIUNG ADGRESS s*eeer <br /> cirv SialE 2��� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRl�CTOR NAME� C rV�Sdvµ C-����. Q D`��'� L' <br /> CONTRACTORA�DRESS: stseeT �fpq �5 S �L 2 � � IO�— �� v �I <br /> n�t Cp V�V�0 d-0V� s,nTe L✓ Q ,�n -1�V l�I�-f 2 � <br /> CONTRACTOR PHONE: CONTRACTOR EMAII: <br /> CONTRACTORIICENSE#(R[�UIRED): C� 5��.� -ILOC1� CITYOFEVERETfBUSINESSLILENSEtt�RE�UIREO�: OS3S2, <br /> PRIMARY CONTACT: ❑ OWNER � CONTRACTOR ❑OTHER(Please Speufy) <br /> CONTACTp N(1AME: CON7ACT PHONE: �(o S� S — �J� S �L <br /> �Q ` F �\ � O � � � � CONTACT EMA�L: J.F 3�- � LO�CQ . h <br /> BUILDING PERMIT APPLICATION <br /> [x�stmg Usc of BuJCing�. Contract Pricc ol Work:5��J___ _— —_ <br /> Proposed Use of Budd�nq� Heat Source. ❑Gas ❑[lectric ❑Other ___ __ <br /> Building T�pe: ❑SFR-Detached ❑SFR-Atlached ❑Dupte* ❑Nulh-I'amlly-#t af Unds._ ❑Commercial ❑Industr�al <br /> lype af Pro�ect ❑New ❑Add�tion ❑Remotlel ❑Repair ❑T I. ❑Sign ❑Sprinkler ❑�emoid�on ❑Change of Use <br /> DESCRIPTION OF WORH: <br /> R �p I a c,:�� S,-a,;�5 <br /> ASSOCIATED BUILDING PERMIT#Uf appiicab!e) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol Project: New AdAn Alteration Repak Type ol Pro�ecl: _New _AdAn _Alleralion _Repair <br /> #°� Lisf ol I"ixfures a�� L�sf of F/�fams p�� Lisf of Fl�tures �°� Llst n/Firtums <br /> Fixtures Fixfwes Firfures Fixfures <br /> NC—Air Ilandhng Unds Hc:�t Pumn inJcl Bar.kllow Preventcr Qm::de Illdgl <br /> Ibrced Au Sysleins Un�t Fieater �athtub Urinal <br /> Gas P�nmq �oder Lava'ory(Wash Bas�n Dnnkmg f=ountain <br /> Water Healer Relrigeration Showcr Floor Drain <br /> Gas Fneplace Wood Stove Kdchen Sink& Disposat Grease Tra <br /> Gas Range Duchn� Dishwasher Roof Drains <br /> Clothes Dryer Hookiips Olhcr. Clothes Washer Medicai Gas <br /> Rangc Hood Water Heater OUier. <br /> Exhaust Fan Smk(ServicelBadMop/elc.) Other. <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Nurnber of Heads <br /> ACKNOWLEDGEN.ENL!Dave revrewetl t�is app!�cuhcn and cnnlim�fhe inlomiulron cenlametl hemrn is fine antl eormct N'ork�one pursuanf to Ihrs permd must comp'y�+,Ih <br /> currenf lede�a(slala,and localla�v. The granhng rl a perm�l oNy eulhonzes appmved�wrk enC no dev:alrons Ihemlmm Oe.�in!iens musl/rrsl6e aufAonretl m wnhng fmm if:v <br /> �mldmg OKcial6elorn heing aufhonred un�er any ci¢umsfance, I am fhe owner,oN am aWho�ized Dy Ihe ownerollhis pmAeRy to pehnn Ihe wnrk lor�vhich eppPcanon a matle. <br /> and I comply ielh the Sfafe Confmcfors Lavi/8 2�RCW and?96200A�h�AC. <br /> C�ry o!Evemtf OHicrel Use Only <br /> ` PERMIT# <br /> �1�,�w,,�f ��,��s� �2 /�y ��s � 151� — 0�5 <br /> Owncr'.�uthorized Agent Signaturc Datc (Nev�se0 70��Z1075) <br />