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PERMIT APPLICATION <br /> BUILDING ;CHANICAL / PLUMBING / SIGN /S'FRiNKLER/ DEMOLITION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P}425-257-8610 � FAX 425-257-8857 �(E}everetteps@everettwa.gov � www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please} PROJECT StTE INFORMATION <br /> PROJECT SITE ADDRESS: � PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaVsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: -Gp �, {,.{� r TENANT NAME(lf Commercial}; <br /> OWNER MAILING ADDRESS: snxeer � � <br /> cirr sraTe �'�/,,� zip �� <br /> 'dWNER PHONE: y� 3,5� �� OWNER EMAiL: <br /> GONTRACTOR NAME r�,}',^'� ' (,jv; ' ' ; <br /> CONTRACTOR ADDRESS: srReer ��- �'�° �'';� <br /> � a �,. <br /> °�� ��.r"C.�'"""4:-,��: _. ' � ziP �-. s "��7� <br /> STATE �,'M1,,,�j W'4" <br /> CONTRACT�R PHONE: �4-�.�{'-� ,.�`. -( t <br /> �"J�' �'��� �� CONTRACTOR EMAIL, j`�'�,,,�?, ��g"�`"y��t..�{��y��,�L2.C�,"C� r�:, ��� <br /> C(7NTRA�TqR LICENSE#(REQUIREDy: 6�,.�r'`�}�..I�l,e;���'1���C�,""�""�'��� CITY OF EVERETT BUSINESS LICENSE#(REQUIF2E0): �,��s��� �y <br /> PRIMARY CONTACT: ❑OWNER ' € _ � <br /> ���N�`RA�7�1R ❑OTHER(Please Specify) <br /> GQNTACT�►AME; a . J CONTACT PHONE: , M"' ," <br /> ��'�;'°���,�� �. �� �-� �,°� � <br /> ,° �t?NTACT EMAIL:Y�✓����t'�i�C��'-�'V'1.��e �` (►J(°�'�' <br /> BUiLDING PERMIT APPLICATION � <br /> Ex3sting Use of�ufldin : Contract Price of Work: � OG3 <br /> Prapcased Use of Buildin : Heat 5ource: Cas ❑Electric ❑Other <br /> S��iidin. Type� FF2-Defachod ❑SFR-Attached ❑Uc�plex ❑Multi-Family,#of UNts: ❑Commercial ❑Industrial <br /> �.YP�of Project. ❑New ❑Addition ❑Remodel Repair ❑T.1. ❑aic�n ❑Sprinkler ❑Demolition ❑Ch�nge of Use <br /> �ESGRIPTION OF WpRK: <br /> �� �� <br /> ASSQCIATED BUILDIN PERMIT# 'ii a pli�abl�): <br /> MECNANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of ProJect: _New _ qddn Afteration _Repair Type of Project: _New Addn Alteratlon Repair <br /> #of — — — <br /> Flxtures ��st of Flztures #of Llst of fixtures #of �/st of Fixtures <br /> #of L/st of Fixtures <br /> Flxfures F(xtures Flxtures <br /> A/C–Air Handling Units Heat Pump ToHet Backflow Preventer(Insid�Bld�) <br /> Forced Air Systems Unit Heater 8att�tu� Urinal <br /> Gas Piping Boiler Lavatary{Wash 6asin) Drinkiny Fountain <br /> UVater Heater Refrigeration S�ts�wer Flaor Drain <br /> Gas Fireplace Wood Stove Kitc:hen�ink&[7isposal Grease Trap <br /> Gas Range Ducting D�shwasher Roof Drains <br /> Clothes Dryer Hookups Qther: �I�athes Washe� f�teclic�I Gas <br /> Ran e Hood Water Heater flther: <br /> Exhaust Fan Sink{SorvicelBarlMap/atc. Other: <br /> SPRINKLER 1 SUP`PRESStON SYSTEM <br /> Number of Heads <br /> aCKNOWLEDGEMENT:!have reviewed this application and confirm the information contained herein is true and conect. Work done pursuant lo this permif must compty with <br /> :urrent federal,siale,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must flrst be authorized in writiny from�he <br /> 3uilding O�cial before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this propeKy to peHorm the work for which application rs made, <br /> rnd!compty wi7h the State Confractors Law 18.27 RCW and 296.200A WAC. <br /> Gily of Everefi O�cial Use Only <br /> �"'� �rj ' � � PERMIT# <br /> . r .' '�. t� �� r^��l.-�l 'j-� ,t�"f���� �� ` �Z' (� �F'�� � � J ! � t� � Zi <br /> FwUn rlAuthorized Agant Sfynature Date �������r r�������,�s� <br />