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• • <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL! PLUMBING/SIGN /SPRINKLER! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www,everettv✓a.govlpermits <br /> (�lue or Black fnk t)nty Please� PROJECT 317E`IN�fJRMATION ' <br /> PROJEGT SITE ADDRESS: � PROPERTY TAX#: <br /> LEGAI.for new construction: Short P1aVsutad(Ylslon laE No.� (attach copy oT long legal descripilon) <br /> CQNTACT INFO!'tM1�'lTlOt� <br /> OWNER NAME: � � TENANT NAME Of Commercial): <br /> OWNER MAILING ADDRESS: srReer � �j <br /> C�N �� STATE �„��' ZIP <br /> QWNER PHONE: �'� �SS QWNER EMAIL: <br /> CONTFtACTOR NAME, � n C <br /> CONTRACTORADDRESS: sTReeT �� Q�„j�(„Q,� <br /> CITY STATE ^�»� ZIP . .�, . I <br /> CONTRACTOR PHONE: ��Q, O �{� CONTRACTOR EMAIL � �°� ,�Q <br /> GQNT�4CT(7R LICENSE#{REt2UlRERJ� �G �tTY CiP EVERET7'SU3fNES81.iGENS��{REGiUIREDI. Q�i'�� <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> Ct?fVTACT NAM��� CONTACT PHONE: j„�.�G�` ZSi� ��� <br /> CONTACTEMAIL: � ���� ,� <br /> BUILDINC�PERMIT APPGICATION ' <br /> Ex'sst+n Use of BuIldi� : � Contract Price of Work:S � <br /> Proposed Use of Bui(ding: Heat 5ource: �s ❑Electric ❑Other <br /> Bwiiding T e: FR-R�t�ched ❑SFR-Attached QRupiex ❑Mult9-Fani11 -Ct of Units: ❑Commercial ❑Industrial <br /> Ty�ae of Rrofecl: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑S rankler ❑Demolition OChan e of Use <br /> DESCRIPTION OF WORK: n��n ^n n C �r'^ ^�n <br /> K LI.CJC� �W.� /l.{ritJ�.X• <br /> AS50CIATED BUILDWG PERMIT# if��a licat�le}: <br /> MECHANICAL PERMlT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration Repalr Type of ProJect: New Addn Alteratlon Repair <br /> #of 1lsteLFJxtures . #of LJst atFJxEures___._. .. #of _......./,,�sf of-Pfxtures _____ #of —.._ Lfstaf-�fxtures _ <br /> Fixfures FTitfuies FJxtures Fixtures <br /> A/C–Air Handlin Units Heat Pum Toilet Backflow Preventer(Inside 81d <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping ��iier Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrig�rat(on Shower Floor Qrain <br /> Gas Fireplace Wcaa�t�tove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ciu�#tn Dishwasher Roof Drains <br /> Clothes Dr er Hooku s Other; Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exha�st Fan Sink(Service/BarlMop/eta Other. <br /> SP!'tINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No,of Heads <br /> ACKNOWLEOGEMENT:I have reviewed this application and conlirm fhe iNorma(ion confa�hedhe�ein is true and conecl. Work done pursuant to fhis permrt musf compty wrth <br /> current lederal,state,and loca!law. The grenfing o1 e pe�mif only aufhorizes epproved work and no devialions fherelrom.Deviefrons musf frrst be aufhorized in wnting(rom!he <br /> Building O�cial before being authorized under any circumstance.I am the owner,or 1 am aulhorized by fhe owner of fhrs property to pedorm the work lor which applica(ion is made. <br /> and!compJy with fhe State Confracfors Law J8.27 RCW and Z96,200A WAC. <br /> City of Everetf Oflicia!Use Onty <br /> PERMIT# <br /> � «' 3�� � � `� <br /> Qw eriAuthorized Ag Sfgnature Date (Rovrssd 9l13�2018) <br />