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PERMIT APPLICATION <br /> BUILDING / MECHANICAL! PLUMBING / SIGN / SPRINKLER i DEMOLITIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 �(E)everetteps@everettwa.gov j www.everettwa.govlpermits <br /> {Blue or Black 1nk t?rtly Pleaae� PROJECT SITE INFORMATIQN <br /> Pf2C7.tECT SITE ADDRESS: �W� }� � PROPERTY TAX#: <br /> LECaAI.for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> t�WF�ER NAME: ��L�-Qc.�j� �Q_ TENANT NAME{If Cotnrttercial}; <br /> OWNER MAILING ADDRESS: srReeT � � <br /> CfTY ��"�«�.,��µZ`C..�l STATE ZIP � V �i✓ � <br /> QWlJER PHONE: �"� p�� �J� (�,2--3 OWNER EMAIL: <br /> CONTRACTOR NAME: �-��,',�"""(�J'�� <br /> CONTRACTOR ADDRESS: sraeer ��� (� <br /> �� STATE �/'"Y �3P ��L...�� <br /> CpNTf�AGTi7R PHONE: "�',� , �} CONTRACTOR EMAIL: �' �� �y��.�,?(,'�,`'�jr'l. . (�?� <br /> C(7NTRA�Td�R LICENSE#(REQUIRED).�,�Y'��°�,�#„j 4"t��`�;��Zd}'"� C1Ty OF EVERETT BUSINESS LICENSE�{t��CdtJl�E�): s C�+�� <br /> FRIR�AFtY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> ���T�������= . CONTACT PHONE: � �'�9 �� <br /> ���:.��� CONTACT EMAIL: .��i.�ry ("�����1 ' ,�ry� <br /> BUILDING pERMtT A�1��t+�A"�'t+�N <br /> Existin Use of Building: Contract Price of Work: $ �"` OD�' <br /> Proposed Use of Buildi� : Heat Source: as ❑Electric ❑Other <br /> Buil�iiny Ty e- �R-Detached ❑SFR-Attached QC�uglex I�Nlufti-Family-t�of UnitS: ❑Commercial �Industrial <br /> '!'ype of Pro,Eqct ❑New '�PAd;lifian ❑Remodel �Re air �T.I. ❑5ign ❑S�rinkEer ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> '��Q,�L��-- (�-� <br /> ASSOCIATEC!BUILDING PERMIT#iif a�� licable}: <br /> MECNANICAL PERMIT APPLtCAT10N PLUMBING PERMIT APPLtCATION <br /> Type of Project: New Addn Alteratlon Repair Type of Project: New _Addn Alteretlon Repair <br /> Fixtures Llst of Fixtures #of L/st o/Fl�Rures #of Lls[of Flxfures �°� List of Fixtures <br /> Flxtures Flxtures Fixtures <br /> A/C-Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basinl Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stave Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other Ciothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and conlirm fhe information contained herein is true and correcf. Work done pursuan�to this permit must comply with <br /> current lederal,state,and local law. The granting of a permit onfy authonzes approved work and no deviations therefrom.Oeviations must firsf be authorized in wnting from the <br /> Building OHicial be(ore being authorized undei any circumstance.f am the owner,o�I am authorized by fhe owner of this properiy to perform the work/or which applicalion is made, <br /> and I compty with the State Contracfors Law 18.27 RCW and 296.ZOOA WAC. <br /> �;ty of Everett Official l/se On/y <br /> ,� ���� A PERMIT# � � I �..-�J �O <br /> � ;,� '�r a -1� <br /> Ownor/AuCharized A�en{Signature Dale <br /> (tievlSecl 912312t7 i 6) <br />