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PERMIT APPLICATION <br /> BUILDING f MECHANICAL I PLUMBING I SIGN f SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERWI`SERVICES <br /> 3200 C�=-pAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1(E)everetteps§everettwa.gov I www.everettwa.gov}permlIs <br /> (Blue or RNick Ink Only Pleas®) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRF63: k? PROPERTY TAX##:a 65 ()0 600 <br /> LEGAL for new construction: Shoat PlaUsubdivisior, Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME= t w TENANT NAME(IF Commercial <br /> OWNER MAILING ADDRESS: STREET <br /> carr sraTE � ziF <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; tA) -50i!A)Gj-TTj,v /Z_ / C�7 67f `• �/ p <br /> CONTRACTOR ADDRESS: STREET 1-71,5 11 b41- — <br /> crrr 'ff ' yl srnYs L10-14- ZIP <br /> CONTRACTOR PHONE: 4'66 3- CONTRACTOR EMAIL. V Ih1 l Ly �Lr�'y7 <br /> CONTRACTOR LICENSE#(REQUIRE []); }�� � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED); <br /> PRIMARY CONTACT: ❑C7vVNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME'_ CONTACT PHONE: <br /> J C 1 r l E CONTACT EMAIi-; 0?6 U0 <br /> 13C111WING PERMIT APPLICATION 7� <br /> Existing We of Build <br /> in. : Contract feriae of ork_$ d to <br /> Proposed Use of B Ilding: Heat Source: s ❑Electric ❑Other <br /> --------------- <br /> Building T e: R-detached 1:15FR-Attached ❑Du Iex ❑Multi-F2mil #of Units- ❑Commercial ❑ln¢u� ial <br /> T.vps Of Pro�ect ❑New ClAddition ❑Remodel Mke air ❑T.I. 115ign ❑S rinkler QDemolftion 010han e o ae <br /> DESCRIPTION OF WORK: <br /> / M "CL- Q14- A07 <br /> / <br /> ASSOCIATED BUILDING PERMIT# if applicable <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: —New _ Addn ,Alteration _Repair Type of Project= Now _Addn _Alteration _aepair <br /> #Of List of Frxiureg #�f #of #of <br /> FiXtUPeS Fixiut'eS List of FfxtUrgg 1=fxtUYQs Fixtures L}Sf o!Fixtures List of t=}xtures <br /> A1C Air Handlin Units Heat Pump Toilet Backflow Prevontor(Inside Bldg <br /> Forced Air System$ Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavata Wash Basin) r)Ffnkfng Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gee Fireplace Wood Stove Kitchen Sink pis osal Grease Trap <br /> Gas Range Ducting Dishwasher <br /> Roof Drains <br /> Clothes D er Hookups Other; Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mopletc.) Other: <br /> 8PRINKL1ER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this application and confirm the informB11017 conta/hed hemin l5 true and correct Work done pursuant to this perrni(must comply with <br /> cuarent federal,stare,arrd locellaw, rhe granting ore permit only authorizes approved work and no deviations thetetrom_Deviations must first be auth0rizad in writing f1pm the <br /> Building 17rrloal before befog authorized under any Circumstance.tam rhe owner,ori ern authorized by the owner of this property to perform the work ror wttM 8ppliceflon is n>ade, <br /> /]OtW <br /> d/c ly with the State Contractors Lew 18.27 RC W and 296.200A WAC. <br /> CCity OFEverstt Official Use Only <br /> erlAuthorlred Agent Signature <br /> Date (Revised 5120/20 15) <br />