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PERMIT APPLICATIOr <br /> BUILDIN�-- MECHANICAL / PLUMBING / SIGN i 51JRINKLER / DEMOLITION <br /> 4*7T CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (?)425-L5,'-g8'0 FAX 425.257-3857 I(E)everetteps evere;lva.gav ( www,avere;:iwa govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE 11 INFORMATION <br /> PROJECT SITE ADDRESS: J Q(I �e �- PROPERTY TAX#: <br /> ;LEGAL for new ont.= ^t;on; ShO;t Pla7`subdivis;4sn <br /> —___...... .�_..—, _—.. Lot No (a"ta:.h coag of long Legal descript''on; <br /> CONTACT INFORMATION <br /> OWNER NAME , t/� °,�` TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS, STREET [oil -F4_:B 1e <br /> .;17 f 7TATF ��7ir � i <br /> OWNER PHONE: 00-Z,4) OWNER EMAIL: <br /> CONTRACTOR NAME, :4Y1 <br /> CONTRACTOR ADDRESS: sTkEEr L <br /> 4 <br /> ,�`"tw.-.T "'T�"\STATE �„�.. LIF <br /> CONTRACTOR PHONE: L"� { CONTRACTOR EMAIL: �; � -{ � .( y y�j Z t � , �ti;r-, <br /> CONTRACTOR LICENSE#(REC2UIRED): 1A4 '' " 7.A v I CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):' <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE; <br /> CONTACT EMAIL: rW-41n-i2 r '-i2J fit C4t , (orv"' <br /> BUILDING PERMIT APPLICATION <br /> xsttn Use of Buildin Contract Price of Work:$ <br /> 'reposed Use of Building: Heat Source Gas ❑Electric ❑Other <br /> luild'rng Type FR-DaOched ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units° ❑Commercial ❑Industrial <br /> Hype of?raject: ❑New ❑Addition 0-Remodel 99pair ❑T.I, ❑Sin ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> )ESCRIPTION OF WORK: <br /> an' GF <br /> 1SSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL. PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: _New Addn _Alteration X Repair Type of Project: _New Addn Alteration Repair <br /> #of <br /> Ofxtu f List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures <br /> AIC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systenls Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater <br /> R;fr-igerafion Shower Poor Drain <br /> Gas Fireplace Woic!Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes D er Hookups Other: Clothes Washer Medical Gas <br /> Ran o Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BartMcp/etc.` other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads <br /> 'KNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is ime and correct. Work done pursuant to this permil must comply with <br /> rrrent federal,state,and local law, The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> iilding Official before being aulhorized under any circumstance.I am the owner,or I am authorized by the owner of this properly to perform the work for which applicatict;is made, <br /> id I comply with,the State Contractors Law 18.27 PCW and 296.200A WAC <br /> City of Everett Official Use Only <br /> vn2riAuthorized Agent Signature Date (Peviaed 9,x2,112616) <br />