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• PERMIT APPLICATION • <br /> BUILDING / MECHANICAL/ PLUMBING I SIGN / SPRINKLER! DEMQLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98241 <br /> (P}425-257-8810 � �AX 425-257-8857 �(F)yv�rettaps ra�vf�r�!#w�.gov� www.everettwa.gov(permiEs <br /> (Blue or Black Ink�t°�ty P1eas�) PRt��E+�T�}"N"� INi�O1tM�TIC��+i <br /> PROJECT 51TE ADDRESS; ��L f PROPERTY TAX#: <br /> L�C+AI for new construction: Short F�la��,ub�iufsl�tn Lns No. (attach copy of long legal description) <br /> CtiNTACT INFORI1+fATlQN <br /> OWNER NAME: C'�` � TENANT NAME(ff Commerciai}: <br /> OWNER MAILfNG ADDRE55: >rFtF,Fr 1..��0� <br /> .. CITY � STATE W� ZIP ....g� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �—������- <br /> CONTRACTOR ADDRESS: srHeeT �`� (� <br /> 'i;I'i`! 5?ATE�/� r'..IP . tl�'�✓� <br /> CONTRACTQR PHONE: � Q CONTRACTOR EMAIL: ����e, � +(,,�C��''�.�'�„'�"j✓l� . �yry� <br /> CONTRACTOR LICENSE�raEc�uiaE��: C(Y11''��Q,Ct�,�L�p'T"Zd}''� CITY OF EVERETT BUSINESS uCENSE a(R�quirt�a�: (L�O�-'[�j <br /> PRIMARY CONTACT: ❑OWNER �l CONTRACTOR ❑ OTHER(Please 5pecify) <br /> CONTACT NAME: • CtJNTACT PHONE: � �`�� �'�, � <br /> �� �f7tYTACT EMA{L' C���l� GrVI Y�.'L"'GL�'t+� •�0 M <br /> BtllL:l.11Nl�'F���t11t11T J1PPl.��A`t'IG41� <br /> Exisii�� Use of BuiIF3lr�g; Contract Price of Work: $ �C�Q r <br /> ?raaoseci Use of B�.�iltilnq: Heat Source: ❑Gas Electric ❑Other <br /> f3uiiding Type: FR-Detachad C7SFR-A[tached ❑puplex ❑Multi-Famil -!i of Units: ❑Commerclal ❑Industrial <br /> T �e of Projer,t� ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑5prin4cf�r ❑Demolition ❑Cf��n e of Use <br /> DESCRfPTION OF WORK: 1�S,J_, 1� GV S�YV�'e1��S y�eQ.� �� <br /> � Ia <br /> t�S50ClATED BUILDING PERMIT#(if�a�rpliva�ala): <br /> MECHAtVICAL PERMtT 14PPLICA710N FLUM6ING PERMIT dPpLICATl�N <br /> Type of ProJect: _New Addn _Alteration Repalr Type of ProJect: _New Addn _Alterotlon _Repair <br /> d of � <br /> Fixtures Llst of Fixtures #�� List of Flxtures #�� Llst of F/xtures #�f LJst of F/ztures <br /> Flxtures FJxtures Fixtures <br /> A/C—Air Handling Units � Neat Pump Toilet Backfiow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrfgeration 5hower Floor Orain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dis osaf Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Oralns <br /> Clothes Dryer Hooku s Other: Clothes Washer Medical Gas <br /> fiange Hood Water Heater Other <br /> Exhaust Fan Sink(Service/8ar(Mo /etc. Other. <br /> �PRINKLER f SUPPRESSIUN SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNO WLEDGEMEPJT:f have revtewed this applicafion and conlirm fhe informaiion contalned heieln ls fnte and correct. Work�done pursuanf to thfs permit must comply with <br /> cerrren!feoeral, stat�t,anr!le�r,ai lavr. 7fre granfing of A pg�mif nnty authonzes epproved work and no devlaflons fherefrom.Devlatlons musf 11rs1 be authorized in wnting from ahe <br /> l3ud��iny L71flt;ial be�/a�rr�betrnc7 autl�a�ize�rt untJer any cfrcum.stonce.I am the owner,or 1 am aufhorized by fhe owner o(fhis properly lo pedorm fhe work!or whlch epplicafion is made, <br /> and!comply with!hc State Confractors Law 18.27 RCW and 296.200A W,�C. <br /> City of Everett O/ficial Use t`7raJv <br /> � PERMIT#�^ ^ O/�' D`_� <br /> �.: G1 'Zl•�? � r�i ��� � <br /> "Qwne/Authorized Agan ignature Dale �Reuisad 5/73/Z01bt <br />