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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER ! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320Q CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 �(E)ever�tt�ps(a?ev�reftwa,gnu� www.everettwa.gov(permlts <br /> (Blue or Black Ink q!n13/P1+���e} Pt;l�J�CT S(TE 1NFCaRMATIt]�N <br /> PROJECT SITE ADDRESS: � (a,�"� �� PROPERTY TAX#: <br /> LEGAI.for new construction: Short�'IaE.�Svbdlvtsic�n Lrst No.�� (attach eopy of long legal descrlption) <br /> CONTACT IWFCYRMA'E'(t!N <br /> OWNER NAME: � ��` TENANT NAME(If Commerclai}: <br /> dWNER MAILING ADDRESS; staeer <br /> C�TM STATE 7�p <br /> OWNER PHONE: ,�,'� ��}j OWNER EMAIL: <br /> CONTRACTORNAME; �-�����- <br /> 'CONTRACTOR ADDRESS: srReEr �'� <br /> C� STATE � /f"�' ZiP �ZO' <br /> CQNTRACTOR PHONE: �'�' Q CONTRACTOR EMAIL: r " � <br /> t:��%�C�I�,'. C�4"1'ik'1�C1.�i✓� � •,C��'1 <br /> CONTRACTOR LICENSE#(REQUIRED): C�(Y��^�;(;� �4�,�'t�j"j"td p-{ CITY OF EVERETT BUSINESS UCENSE 8(REQUIRE ): {{,p� � <br /> PRfMARY CONTACT: ❑OWNER �S CONTRACTOR 0 OTHER(Please Specify) f <br /> i <br /> COM1tTACT NAME: ^ CONTACT PHONE: � ��C� ��� ��_�.-` ' <br /> �I��l:�� CONTACT EMAIL: ��}�! 'e � � ��M <br /> � �au��r��r������tT a���.�c�arror� �_ <br /> Existing Use of Bulittin � Contract Price of Work: $!,�. �•� <br /> f�roposed Use oi Builciirrg: Heat Source: as Electric Other <br /> E3uildir3 T pe: FR-C}�tached ❑SFR-Attached ❑Clt�ptex �Multi-F�mi1 -f�of lJn{fs; �ommercial ❑Industrial <br /> Zy}��of Project ❑New ❑Addition ❑Remodel ❑f��:pair ❑T.I. ❑5ign QSprinkler ❑Demolition ❑Ch�r�ya�of Use <br /> DESCRIPTION OF WpRK: <br /> �� <br /> A550CIATED BUILDING PERMIT# if ap licable": <br /> MECHANtCi4� PERMIT APPt�ICATIt1N P�.UMBING PERMI'i"ARPL.ICATtON <br /> Type of Project: _New _ Addn or lan _Repalr Type ot ProJect: New _Addn Alteratlon Repair <br /> #of #of #�f — <br /> Fixtures List o(Fixtures Llst of F/xtures #of ��sf of Flxtures Llst of Fixtures <br /> Fixtures Flxtures Flxtures <br /> A/C–Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bid ) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler LavaEo Wasta$asin� Orinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen 5ink&Gtisposal Grease Trap <br /> Gas Ran e �uctin Dishwasher Roof Drains <br /> Clathes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Servlce/Bar/Mopletc. Other. <br /> SPRINKLER/�UPP�tE�SIpN :iY�T�NI <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed lhrs appticafion and conlirm the information contained herein is true and correcf. Wo�k done pursuant lo fhis permif musl comply wilh <br /> current lede�al, state,and Iocallaw. The gianfing of a permrf only aufhonzes approved work and no deviafions there/iom.Devlaqons must lirsf be aufhoriznd/n wrrfing from lhe <br /> Buildrrig OKicial be%�e 6eing authorized under any circumstance.I am the owner,o�1 am aufhoilzed by lhe owne�oi Ihis prope�fy to perform Ihe work lor which app/lcafion is made, <br /> and 1 comply wifh Ihe Sfafe Conlractors Law 18.27 RCW and 296.200A WAC. <br /> C'rty o/Everett ONicial Use Oniy <br /> J 5�!� l Q��� v•/ PE� — O� � <br /> 'OwnoFlAuthonzed AgenfS�gn��____— ` �e/ � <br /> (Rewsed�/23!20f6) <br />