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PERMIT APPLICATION <br /> BUILDING �CHANICAL / PLUMBING / SIGN / S�KLER / aEMOLtT10N <br /> CITY OF EVERETT PERMIT SERVICES <br /> � � ,:�, <br /> 320C CE�AR STREE 1�, Ei/E2ETT.WA 98201 <br /> {r'i 17�-�j7-di3':�s f rAX 425-257-8$57 �(E}Aver�Ct�Ers�e�vUrett�va gnv( av�Mrrev:rfl#iw3.c�oviper:;�i[s <br /> �B1ue or Black Ink�nly P�ease� PROJECT SITE iNFORMATION <br /> PROJECT SITE ADDRESS � � PROPERTY TAX#: <br /> L���L fr�r new cc+r�st-�..u:�n: Sh�oR!'I�[is,�bdiv>;_is= �� � �� �� � � � � <br /> - — LpC�Jn iarach�opy oP;ong l�ga �..��..rpC or,y <br /> CONTACT INFORMATION <br /> OWNER NAME: ,�������'j��j�..�..�... TENANT NAME(!f Commerciai} <br /> _ ;3 <br /> OWNER MAILING ADDRESS: >rr>E,r qO � ��� �oM J <br /> - a. <br /> ::,� �%�'� � ���� <br /> y,�t�r <br /> OWNER PHONE: �- t-L(�� (.��� t�WNER EMAIL: <br /> CONTRAC70R NAME ����j,4 :� . �� '7 " <br /> CONTRACTOR ADDRESS: sr��.r�� ���'�'� ������ �� �� � <br /> �/� �. 'L.' <br /> (;�1Y �1+�"!�'� f_� � L� ... <br /> '= ' S7A7E �'13`Y'"[ rIP �-- ����'t <br /> CONTRACTOR PHONE: ��,`� ,.��i�{ �'f..�� ��� j CONTRACTOR EMAIL: jf�`�„� Y,��.�-{"�},'� 1( �yy-�,t,2��`tt <br /> �c c n,�d'� <br /> CONTRACTOR UCENSE#�REQUIRE6), ,w�r`} _� `�° <br /> � ��� <br /> � � ���...��`��-�'�`�� ����_Y� CITY OF EVERETT BU3lNESS LICENSE REQ�IIREQ}.}{ ��{ � <br /> � � <br /> .� �z <br /> PRlMARY CONTACT: C]pWNEa ` ���Y����-�� �OTHER(Please 5pecify) <br /> CONTACT NAME: • _ � – <br /> � CG3NTA�T PHONE: � <br /> � <br /> ��°� '' � ����' �:� ��'f �,,>� <br /> �� `` CONTACT EMAIL: � r s <br /> �-��t� t��- :: C-�'Y�,�ti�:t� �' ;' ���/v� <br /> : <br /> BUILDING pER14l1T APPLICATION <br /> =��tin���Use of B�ticfi�n����� Contract Price of Work:$ <br /> 'rt�p�se�Use of Buildin. Heat Saurce: as ❑Electric ❑�ther <br /> 3uilding Typt� 5=F2-��!�tihe� ❑SFR-Attached ❑�u�atex ❑Multi-Fami�y#oF Units ❑Cammercfal ❑Industrial <br /> �`y;��of�'ra'ert: ❑New ❑Addition � � Rem�del �R�p��r ❑T.I. C.����n L]�prinkier ❑Demolition �CE�an�e of Use <br /> SESCR1pTiON OF VIrOFtK: <br /> ���! '�''�"' � <br /> 1550CIATED BUILDING PERMIT#{if a plreaol�?; <br /> M�GHANICAI. PERNII'T APPLICATION PLUMBING PERMiT APPLiCAT10N <br /> ype of Project; _New _ Addn _qlteration�Repair Type of Project: New Addn Aiteration <br /> Repair <br /> #of — — — — <br /> �lxtures List of Fixtures #of �°f List of Fixtures #of Llst of Fixtuies <br /> Fixtures Llst of Fixtures <br /> Flxtures Flxtures <br /> A/C-Air Handling Units Heat Pump Toilet 8ackflow pr�v�nter(Ins{de BfrJ � <br /> �orcad Air Syster�as Unit Heater � <br /> ������� Urinai <br /> Gas F'iping Boiler Lavatory(�/V�sh Basin <br /> Water Heater ) Ctrinking Fount�in <br /> Refriyeratit�n Sho4var �1ns�r Drain <br /> Gas�irep(�r,� Wood Stova �'� <br /> Kit���n Sink�E?isposai Grease 7ra� <br /> Gas Range Ducfing �7������{��� ��t Drains <br /> Clothes Dryer Hookups Other. Clc�thes Washer tviedica!Gas <br /> Ran e Hood Water Heater Other. <br /> Exhaust Fan Sink($ervrcetB�rtMo�letc.) Other: <br /> SPRtNKLER/BUPPRE$�ION SYSTEM <br /> Number,�r N�ads <br /> ;KNOWLEDGEMENT.I have reviewed ihis application and confim�the infarmalion contained herein is true and coriect. Work done pursuant to�his permH mus/comply with <br /> rrent federal,state,and local law. The granting of a permit only aulhorizes approved wcik and nc deviations therefiom.Deviations must fir.st be authorrzed in writing trom the <br /> iilding O�cial before being aulhonzed under any circumsfance.1 am,!he ownec,cr!am authorized by 1he cwner of this propedy tc psdcrm the work(or which apF6cation is m.ade. <br /> d i compty with the S1ate Ccntractors Law 78.27 RCW and 296,2GOA WAG. <br /> Gity of Everetl O�cial Use(;nk�r <br /> �rr',, � �` /� ��-�t� { PERMI #� ` Or � <br /> 'P �� �� '� � � ,,�+ ���} ��' � � <br /> /� ��C,,, �, r%'�`�l...r -} „;•�.-t: f; y. C �+ � 1 <br /> vnerlAuthorized Agent S�gnature �at� jR�sr�n�t�l.;,"3;1,=�75) <br />