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. • <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL(PLUMBING / SIGN 1 SPRINKLER I DEMOLITiON <br /> CfTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-g810 � FAX 425-257-8857 �(E}everetteps@everottwa.gov� www.everetfwe.gov/permiis <br /> (�1u� or Black Inic t�nly Ple��e) :P�+Ci.�l:�"'6"31"M"E 1�L��ttMATtO,N <br /> PRC?JECT SITE ADDRESS: 2 �.D�} ��,,� �„�� ,�,iG PROPERTY TAX�: <br /> �EGAL for new� ���s,n.cfian� Sho�t F�I s'.:�c�o�if4i^,lr�€r t_�i9 No. (attach copy of long legal descripfion} <br /> COtdTACT II+t�ORMATIOM <br /> OWNER NAME: �- �„1� Q�� � TENANT NAME(If Commerciai), <br /> C�WNER MAILING ADDRESS' srk��r �,.,�Q y- ��„ � � �J <br /> °'r'' ;-nT� �F}- pi��-1 � .c,'�...� � <br /> QWNER PHONE� GtWNER EMAIL: <br /> C{JN7RACTdR NAME. t—��,����— <br /> CONTRAGTC?R ADDRESS: srHeEr ��� � <br /> ;•'r`' srnrE VV/� z1° CJ��� <br /> CONTRACTOR PHONE:t- � Q CONTRACTOR EMAIL: �C�►'„��„1I�.. � G�Y'I��GL'�`t�� ' Gt7}'Y't <br /> CONTRACTOR LICENSE#+��ruiaer��: C�Y1��1�,�`1�j'7 Zd t'� CITY OF EVERETT BUSINESS UCENSE#(REQUIR�!?y: l�� <br /> �_,_ <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> -- - . _ <br /> CONTACT NAME: ` CONTACT PHONE: � ��� ���, <br /> �� CONTAC7 EMAILr � i,�I ('���?��� .�M <br /> Bt,,�tL�t�t� PERMlT A�"f�LICATIG►Iai <br /> Exist�s�r� Use of�s��i1�1��� Contrect Price of Work:� �t� "� <br /> Propos�d Use of Builcl�ng. Heat 5ource: OGas OElectrlc ❑Other <br /> Buildin Typr�� �FR-Detached ❑SFR-Attached (�L�etplax ❑�v1talti-Famii -#of Unfts� ❑Commercial ❑Industrfal <br /> 7y�r�of Pr�jor,t: L�New ❑Addition ❑Remodel ❑F�Ppair �I�T.I. ��5ic n ❑SprEnk3�r ❑Demolitlon 13�;hang�of Use <br /> QESCRIPTION OF WORK: �� �� �� �����SS �,'e L� ��.� <br /> ASSC7CI�IFED BUILDtNG p�RMIT#{if aF���flcab�a�: <br /> MECHAhiICAL PERMIT APPLICATtQN PLt1MBING PERMIT APPLICATION <br /> Type of Project: `New _ Addn _Alteretion _Repair Type of ProJect: _New Addn _Alteratlon _Repair <br /> it of L/st o/Flxtures �of <br /> Fiztures Fixtures L/st of Flxtures Fixtu es Lfs�of Flxtures #of Ust of Flxtures <br /> FTxtures <br /> A/C—Air Handlin_ Units Neat Pump Toilet Backflow Preventer(Inside Bldgj <br /> Forced Air 5ystems Unit Heater Bathtub Urinsl <br /> Gas Piping Boiler Laveto (Wash Basin) Drinking Fountain <br /> W ater Heafer Refrigeratlon Shower Floor Drain <br /> Gas Fireplace Wond Stove Kitchen Sink&Disposai Grease Trap <br /> Gas Ran e Quctin Dishwasher Roof Dralns <br /> Ciathes Dryer Hoekups ' Other: Ciothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Other <br /> SP�itiMKLER I SUPP'RES�It7l'�1 81f5�TEM <br /> Chemical or Water No, of Heads <br /> ACKNOWLEDGEMENT.�!have reviewed this application ard conJirm!he Jnformafion containsd hesein is trve and conect.LNr+rN done pu�suanl ro rhi,permit must comply wifh <br /> r.i�rrent federa(,stato, and focal law. The granting of a permit only avthonzes approved work and no deviations Iherefrom.Devla(rons must Rrst be authorized in wrriing from the <br /> 6uilding C,Nlcial before being auehonzed under any circumstance.1 am ihe owner,or 1 arn at;tharized by fhe owner of fhis property!o petform the work for whlch applicafion rs made, <br /> ard 1 con�ply wifti fhe Sfafe Contraciors Law 1H.27 RCW and c96.ZOCl+1NA!;. <br /> C�ty o!Everett OHicial Use�J�.lt� <br /> � '�N'9✓ �. , G��`I PERMIT� �/7 � ���� � <br /> 'C3wno t/�u#h4rizad Agent IgnatGire 02Pe {Revrsed 9;2.?/201�J � � <br />