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� � <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING !SIGN/SPRINKLER/ DEMOLITIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320Q CEDAR STREET,EVERETT,WA 98201 <br /> (P}425-257-8810 � FA?t 425-257-&857 �(E)everetteps@everettwa.gov� vrww.everettwa.gov/permits <br /> (Blue or Black Ink Only Piease) PROJECT SITE INFdRMATiON <br /> PROJECT SITE ADDRESS: �� (� t'� � PROPERTY TAX#:�lC��(c�'IQQZC�C.1� '�,,`+Cg <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of�ong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �;� ` �� .;� ��,� TENANT NAME(if Commercialj: <br /> OWNER MAILING ADDRESS: r szaeEr ��,w l��° � ���y�, <br /> C(TY �J• i(�l 1 STATE ��1� 21P ,G.�.. <br /> OWNER PHONE: �,'1 �j,� ' � OWNER EMAIL: �Etl'• Y�'CY�,� � ' �aG�.C�rz <br /> CONTRACTOR NAME: �1 j�,� �t r s�' <br /> CONTRACTORADDRESS: srReer (�1'��. L: l'_:...` � � <br /> CITI' �{i IC�` STA7E �� ZIP ��Z�r <br /> CONTRACTORPHONE: 2�_ L���.S?��j CONTRACTOREMAiL: {'r'�r„'�:'i��,a� (������,. tC�t�-� <br /> CONTRACTOR L[CENSE#(REQUIRED}: � �(„_'Z�,�;�� � � CITY Of EVERETT BUSINESS UCENSE#(REQUIRED):'—t�C Z�� <br /> PRIMARY CONTACT: p OWNER EirCC1NTRACTOR �OTHER(Please Specify} <br /> CONTAC'T NAME: CONTACT PHONE: L.{��"j_ f�C�:�,-�"�,��� <br /> ��`� �������1 CONTACTEMAiL: <br /> �1�it�c�C. cc-- 6;���C� -tC�� <br /> BUILDING PERMIT APPLIGATION <br /> Existin Use of Buildin : Contract Price of Work:$ �� �� <br /> Proposed Use of Buiidin : Heat Source: �Gas ❑Electric ❑Other <br /> Buildin T e: Ct^'I�S�FR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famil -#of Units: �Commercial ❑Industrial <br /> T pe of Pro'ect: �New �Addition ❑Remodel BRepair ❑T.I. ❑Si n ❑Spri�kler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> �,"�r� ;;. 1�:�-c�-c r��c� ��al�cc�.e��: <br /> ASSOCIATEQ BUILDING PERMIT# if a licable: <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLIGATION <br /> Type of Project: New Addn Alteration �Repair Type of Project: _New Addn Aiteration Repair <br /> Fixiu es un of Fixiures Fixtures �st of Fiartures Fixtures �-'�of Frxtures FJxtures Ust of Fi�rtures <br /> AJC—Air Handlin Units Heat Pump Toilet Backflow Preve�ter(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler Lavato ash Basin Drinkin Fauntain <br /> Water Heater Refri eration 5hower Floor Drain <br /> Gas Fire tace Wood Stove Kitchen Sink&Dis osal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes D e�Hookups Other. Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mo /etc. Other. <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> Chemical ar Water No.of Heads <br /> ACKNOWLEDGEMENT.�1 have revrewed this applicaGon and Confirm fhe informatiort contained herein is true and carect.Work dorte pursuant to this permit must compty with <br /> cmrent federal,state,and locat law.The grantirrg of a permif only authorizes approved work and no deviations therefrom.Deviations must first be authorized rn writing trom the <br /> Building Official before being authorized under any circumstance.!am the owne�or 1 am authorized by the owner of lhrs properry lo perlorm the work for which application is made, <br /> arrd!comply with the State Contractors Law i8.27 RCW and 296.200A WAC. <br /> Gty of Everett O�cial Use Onfy <br /> �`��-- �� r Z:7 I �� PERMi � I� l � � V� <br /> l <br /> Owner/Authorized Agent Signature Date (Revised 9f23/2016} <br />