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PERMIT APPLICATION <br /> BUILDING.ECHANICAL I PLUMBING / SIGN lRINKLER / DEMOI_ITION <br /> CITY Of- EVERETT P[RNIT SERVICES a _I _'� <br /> 3200 CEDAR STREET, EVERETT,WA 90201 <br /> �ri nzs-257-8810 I FAX 425-257-8857 �(E)everetleps@evereftwa.gov� vnN�everetNra govlpermrts,�� �6o a��., <br /> PROJECT SITE INFORMATION <br /> PROJ CT SITE AD RES PROPERTY TAX N: <br /> � M�,ti.P�,. ��e, <br /> LEGAL loi new construchon Short PlaVsvbdivision Lcl No._ (alta�h copy ol iong legal descnpuon) <br /> CONTACT INFORMATION <br /> OWNER NAME: {�o��J✓Q G �1Q ( TENANT NAME(If Commercial�: <br /> OWNER MAILING AD�RE�S: sraeer J J S "� / "l(A G I'lA�Ilq �V�,_ <br /> ��TM .�e rn,�-4-- S.a.E t,� �,� 2 <br /> OWNERPHONE: ZOVJ. , (Z S OWNEREMAIL: <br /> CONTRACTORNAME-. � �S �IU6L��1 <br /> CONTRACTORADDRESS: sTaee* I3 �� 57�-- /`�[% <br /> arv �- � �� srr,rE �J� r� q 2 Z <br /> CONTRACTOR PHONE: . p7Q l} O CONTRACTOR EiNAIL: lIf$, Iu,t�nh i � �-9n.q•I .C,o <br /> CONTRACTOR LICENSE#(RE�UIRED): �A /S P�� O L� CITY OF EVERET7 BUSINE55 LICENSE a�RE�UIRED�:� � <br /> PRIMARY CONTACT: ❑OWNER �COIJTRACTOR ❑OTHER (Please Specify) <br /> CONTACT NAME CONTACT PHONE: �.z DI O <br /> �,/��,�I �/ CONTACT EMAIL: n/ICS [wWt�. '� I'1^q.I � LO <br /> v �vv f <br /> BUILDING PERMIT APPLICATION <br /> Existing Use or[3uiltling Contrac[Price of Work: 5 _— <br /> Propesed Use of Building� Heat Source�. OGas ❑ElecVic ❑Other <br /> Fiwlding Type- ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑tv7ulh-Family-#of Umts ❑Commercial ❑Induslnal <br /> lype of Pro�ect ❑New ❑Addil�on ❑Remodel ❑ReOair ❑T I OSign ❑Spnnkler ❑Demchtion ❑Change of Use <br /> DESCRIPTION OF WORK: (1 � /,� GI S '-!� �Y.l{1 Q , <br /> iy„ / � <br /> ASSOCIATED BUILDING PERMIT#(d applicable). <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type ol ProjecC New Addn Alteretion Repair Type oi Projec�: New AdJn __A��eration _Repair <br /> a°� List ol Fixfures ��� List o/Fixfures ���� f.isf oI Fixlures ��� List o!Fix(ures <br /> Firfuics Fixfures FixGires Fiztures <br /> A!C-Au I�anAlmg Units Heat Pump Totlet 6ackflow Prevenler (Inside[31dg) <br /> Porced Mr Systeins Uni�Hedter 3athtut Urinal <br /> " Gas Piping E3a�!ar Lavato�•(Wash�asinl Drinking Pountain <br /> Water Heater RefngeraUon Shower Plnor Drain <br /> Gas Fireplace Wootl Stove Kitchen Sink 8 Disposal Grease Trap <br /> Gas Range Duchng Dishwasher Roof�rains <br /> Clolhes Dryer Hookups Other. Clothes lNasher _ Medical Gas <br /> Range Flood Watei Heater Other: <br /> Exhaust Fan Smk+SerncelBadMepletc) Olher <br /> SPRINKLER / SUPPRESSIQN SYSTEM <br /> Number of Heads <br /> ACKNOWLEOGEMENT I have reviewed fh¢apphcaLon anJ confirtn fhe mlortnafwn ronfa�ned he�r,m is frve and correcf Work tlone pursuanf lo fhis permd mus(comply wifh <br /> cuimnt lederai,slale,ana rocalla�v. T�e g.anhn9 0l a pemnl only aufhonzes approved n�orN and no dewaGons therelmm.Oeviutions must(irsf Ee aulhcnzetl m wnlmg 6om fhe <br /> Bmltlmg OHrcial be/ore being aufhon:etl under any a¢un I am!he o�vner, or I am eufhonzed by Ihe m•+ner o/Ihis propMy fn pciform Ihe work lo�whrch applicalron is maQe, <br /> antl�comply wrtlr fhe Sfafe Con(ractoz La�v IB D and 2 200AWAC. <br /> City a1�vrrefl OHsial Use Only <br /> � I I/ PERMIT# � / / �Z�W� � <br /> �� <br /> ( �F� <br /> OwnedAuU�orizc genl Signaturc D'e�e (Rewsed 10.�7�075) <br />