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• PERMIT APPLICATION � <br /> BUILDING J MECHANICAL/PLUMBING /StGN / SPRINKLER ! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-257-8810 J FAX 425-257-8857 �(E)everetteps@everetiwa.gov J ww�nc.averettwa.gc�v:'permits <br /> (Blue or Black Ink O�iy Pl���e) PROJECT SITE INPORMAT[QN <br /> PROJECT SITE ADDRESS: �� '�„�;;,�,�� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lert No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OUYNER NAME: �'{, ��, (�,,, TENANT NAME{It Gommercialj; <br /> {?WNEf2 MA�LING ACfCTFtESS, srREeT O�O � <br /> C�T�' ��� S7ATE �/w i ZIP � �2�'� <br /> OWNER PHONE: � �ZS� i,�,� t- QWNER EMAIL: <br /> CONTRACTOR NAME; �~'��"'"��� <br /> CONTRACTOR ADDRESS: srneeT ��� (� <br /> C� . .... . STATE W� ZIP �ZO� <br /> �C3NTRACTC7�R PHONE: � (� CONTRACTOR EMAIL: (� ��'°�.�(�„'�-a✓I. • �y� <br /> Ct7NTRACTQR LICENSE#(REOUIRED):CM��C' 1'Y�,V��"'�ZLIY� CITY OF EVERETT BUSINESS LICENSE#(REqUIRED): tt,pC,�Zy <br /> PR�IVIARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> �C?�iTACT NRCN�: 't' CUM7AC't"PHONE; c�S ,�� t �J_a�+ <br /> ��4�`�....�h i" � CDNTACT EMAIL: ��f'�1 (�i�l��,a�1,� ,jp ry) <br /> BUILDtNG PERMtT APPLICATION <br /> �xlslin Use of Buildin ��: Co�tr�ci Price of Work:� �� � <br /> Prnpos�d Use of 8uilciin : Heat Source: Gas ❑Electric ❑Other <br /> E3uiicfing T e: 5FF2-t�etached ❑SFR-Attached ❑Du Iex ❑Muiti-Famil -#of Unifs: OCommercial ❑Industrial <br /> Type of Pro'ecfi ❑New ❑Addition ❑Remodel e eir ❑T.I. ❑5i n C7Sprinkler ❑Demolition ❑Change of Use <br /> DES�R4PTION OF WORK: <br /> ��''1e�,��2. G,q S FU.�z.�.�- <br /> ASSQCI,ATEt7 BUILDING PERMIT# If applicebla�: <br /> MECHANICAL P�RMIT APPLICATION PLUMBING PERMIT APPLIGATION <br /> Type of ProJect: _New _ Addn _Alteratlon�0 Repafr Type of Project: New Addn _Alteratfon _Repair <br /> Fi tu es List ol Flxtures Flxfu es �lst of F/xtures #°� Ust of Flxtures �°� Ust of Flxtures <br /> Flxtures Flxtures <br /> A/C–Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bidq} <br /> Forced Air 5 stems Unit Heater Bathtub Urinal <br /> Gas Pi in Boiler 1,a��tt+ry�Wash��3'tn} Drinkin Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove K'rtcC�en Sink&C3is ossl Grease Tra <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood '1l�/ater Heater Other. <br /> Exhaust Fan 5ink(ServicelBar/Mo /etc. Other. <br /> SPRINKI.ER/SUPPRESSfON SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have revlewed this applica�ion and conlirm the information contained herein is fiue and conect.Work done pursuant fo this permif must comply wifh <br /> current tederal,stale,and local law. The granting o1 a pe�mit only authorizes approved work and no deviallons there/iom.Devlations musf t)rst be autho�ized in wriling from the <br /> 8uilding ONiclal be%re being authorized under any circumstance.I am fhe owner,or 1 am authorized by fhe owner of this pioperty to perform fhe work for whlch application is made, <br /> and 1 comply with 1he State Confractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett ONiciaf Use CSnly <br /> �CL _ I��1��i�:�t/U _s��� � �� PERM� � —�/, <br /> OmnerJkutharized'Ag�nt 5ignature Date \O <br /> �Ravised 9l�31201&} <br />