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PERMIT APPLICATIC , <br /> BUILD / MECHANICAL / PLUMBING / SIGII I UPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT, A)A 982€31 <br /> ?Pi,t 25.257. 8+, y ! FAX 425-257-8857 1(E)everatteps��evere!iwa.gov I www zverettwa.govruer+n is <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � p4e" Aki PROPERTY TAX# <br /> LEGAL to new constrict ori: Short P€at s o+iv€sir:n Lot No (ittacrS copy of Fong'eyal descr.or;on; <br /> _ CONTACT INFORMATION <br /> OWNER NAME: I *LXWQd TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: ,rrz=:-T <br /> �=%— 0 <br /> STATE <br /> OWNER PHONE: Ld } W') '4 97- OWNER EMAIL: <br /> \AAAA- <br /> CONTRACTOR NAME, . ; € ) <br /> CONTRACTOR ADDRESS: STREET (t. : r LjL <br /> c€rY <br /> } <br /> . <br /> �. �.. STATE <br /> , y <br /> � 2' :74r <br /> CONTRACTOR PHONE: 'B{ <br /> s CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): t�t!�' t �j i /7'1L " CITY OF EVERETT BUSINESS LICENSE#(REQUIRE <br /> PRIMARY CONTACT: ❑OWNER CONTgACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: < — <br /> CONTACT EMAIL: t�'tQ jL^�sl* �LYI,p, c Cl �rJM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: a� <br /> 'roposed Use of BuildingHeat Source: s � ❑Other <br /> 3uildin Type FR Detached ❑SFR-Attached ❑Duplex ❑Multi-Family,#of Units: ❑Commercial ❑Industrial <br /> ype of Project: ❑New ❑Addition ❑Remodel ❑Rdfair ❑T.I. ❑Sign ❑S rinkler ❑Demolition ❑Change of Use <br /> )ESCRIPTION OF WORK, <br /> ►SSOCIATED BUILD) G PERMIT#(if applicable) <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: _New Addn Alteration _Repair Type of Project: _New Addn Alteration `Repair <br /> #of � — <br /> �ixtures List of Fixtures #°f List of Fixtures #°f #of List of Fixtures <br /> Fixtures Fixtures List of Fixtures <br /> Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Roiter Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floar Drain <br /> Gas Fireplace Woad Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other; <br /> Exhaust Fan Sink Service/Bar/Mop/etc, Cather: <br /> SPRINKLER/SUIP01USSION 6YSTEM <br /> Number of Heads <br /> :KNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> irrent federal,state,and local law. The granting of a permit only authorizes approved work and a do is true <br /> therefrom.Deviations must first be authorized ui writing film.the <br /> Matingco Official before being authorized under any circumstance.1 am the owner. or t am authorized by the owner o1 this properly to perlcrm the work for which applicaticn is trade. <br /> +d t comply with the State Contractors Law x.27 RCW and 296.2GOA WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> rvner/Authorized Agent Signature Date, (Reviseif g% 312t,}63) <br />