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PERMI'T APPLICATIO , <br /> BUfLDiN ECHANICAL 1 PLl9MBING 1 SIGN / �INKLER / DEMOLITION <br /> CIi"Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> �� <br /> (P)425-257-88'f 0 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� �nnvw.everettwa.gov/permits <br /> (Blue ar Bfack Ink Only Please) PROJECT SITE lN�ORMATION <br /> PROJECT SITE ADDRE:SS: ���� �'�q�� �'aP�i�`-�� PROPERTI�'TAX#: ;�•"����;'�m�;� ����� <br /> LEGAL fer new constructi��n: Short PIa+Jsubdivisior, I_ot No. (attach copy of long legal description) <br /> � CONTACT t�IF4�F�M�1TlON <br /> OWNER NAME: �,���,�,s� ���:�;.,�@ti� TE�iANT NAME(tf Commercial}; <br /> OWNER MAILING ADDRESS: s-r�eeT E�„�a; ��ar'�«�'; �,t�et�t;� <br /> . CIT1' w�.+���I�''{�`� STnTE �P"; ZIp �+��t� { <br /> OWNER PHONE: �{��� �r�� , ���� OWNER Ei1A,41L: *���'�=:,1`�If�� � pa <br /> ` `��,�A�'�°c��, �� <br /> CONTRACTOR NAME:� �l eC i.�e�°�i'��. C�hI°�"�(��tG.'°�t�e t°� � 1''�4 i��� �,�A+��,�s�'°��'J� <br /> CONTRACTOR ADDRE;SS: srReeT ��'� ���; �'�`�,,� <br /> ciTv �.`��br°�k.1���� sTc,re �/� ZiP ��£�s��� <br /> CONTRACTOR PHONEi: ��g,�,��� , �¢���a CONTRAC:TOR EMAIL: ��•���`;,,�a`: ��i a �:::,�, ;�,.��� <br /> CONTRACTOR LICEN sE#(REQUIRED): �1�K,��.;�{ea�±�„��� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED};��q� .`�� <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR �OTHER(Piease Specifyj ���f�k"�'�.�� <br /> CONTACTNAME: ��i�,� ��g������ CONTACT'PHONE: ���6 �s�� ?��p�,� <br /> �i��i;,"a �l��`�t�`� � ,+��s"�='�:9,+�'�,��,a CONTACT'EMAIL: �4`���"����!��``�A�t��i�E°i°�:.d"�°�c•a��f""S <br /> �UItDING PERMIT APPL(CAT10N <br /> Existing Use of Building: �� Cor�tract Price of Work:$ �'�,� �"� <br /> Pro osed Use of Buildinq: �� He�.t Source: ❑Gas ❑Electric ❑Other <br /> Buildin Type: �SFR-C)etached ❑SFR-Attached ❑Dupiex ❑Multi•F2mily-#of Units: ❑Commercial ❑Industriaf <br /> Type of Pro�ect: ❑New� �Addition ❑Remodel ❑Repair ❑T.I. CGSign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WO:F;K: ,,c���t"�"a�� s� `T�� ��Y�P�'�"�`��.y 1��" ,���� �+��� <br /> ASSOCIATED BUILDIMi3 PERMIT#(if applicable): <br /> . <br /> MECHANICEOL PERMIT APPLICA"TION PLUMBING PERMIT APPLICATION <br /> Type of Project: New~ Addn Alteration `Repair Type of Project: New Addn Alteration Repair <br /> #�f List of Fixtures #of List of Fixtures #of List of Fixtures � #of Lisf of Fixtures <br /> Fixtures FTxtures Fixtures �Fixtures <br /> A/C—Air Hanciling Units Heai:Pump 1�oilet Backflow Preventer(Inside Bid } <br /> Forced Air S s;tems Unit Heater f3athtub Urinal <br /> Gas Piping Boilar !_avatory(Wash Basin) Drinking Fountain <br /> Nlater Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove l:itchen Sink&Disposal Grease Trap <br /> Gas Ran e Ducting iJishwasher Roof Drains <br /> Clothes Dryer Hookups Otha_r: Clothes Washer Medical Gas � <br /> Range Hood 1Nater Heafer Other: <br /> Exhaust Fan ` ,`•.iink(Service/Bar/Mop/etc.)i Other: <br /> SPRINKLER I �UPPRESSION SY.�aTEM <br /> Number of Heads <br /> A.CKNOWLEDGEMENT:!ha✓e reviewed this applrcation ancr confrrm the information contained herein is true and correct. Work cone pursuanf to this permit must compty wdh <br /> current federaf, state,and Ioca1 law. The granting of a permit only authorizes approved wo�k and no deviations therefrom.Deviaticns mus:first be authorrzed in wnting from the <br /> Building Ofiicia!before beiny authorized under any circumstaxe.!am the owne�.or!am authon2ed 6y the o�vner of this properry to perform the work for�vhich appiication is made. <br /> and/compl ith the State G�ntractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Offrcial tJse Or,ly <br /> PERM!"I"# <br /> .._ 7 � /�' �� � � �2� � '��� <br /> wner/Auth :�i�nature Date � (Revised��/20/2016) � <br /> �(z <br />