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� • � <br /> PERMIT APPLICATION <br /> BUILbING ! MECHANICAL I PLUMBING/SIGN / SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-257-8810 � FAX 425-257-6667 �(E}sver�[tepSQ�vetet�va,g�v� www.everettwa.govlpermits <br /> �Blue or Black Ink Only Pl+�aa�) PROJECT SI"t'E"'INFORMATION <br /> 'PROJECT SfTE ADDRESS: � PROPERTY TAX#: " <br /> LEGAI.tor new construction: Short PlaUsubdivislon Lot No. (attach copy of long legal descriptlon) <br /> CONTACT INFORMATt�N <br /> OWNER NAME; TENANT NAME(if Commarciat};. <br /> Gt1NNER MAILING ADDRESS: sraeEr �" <br /> �iTM � � SiA7E �iP <br /> OWNER PHONE: — OWNER EMAIL: <br /> CONTRACTOR NAME, n }+'�� <br /> CONTRACTOR ADDRESS: srReer `� �,�(,,�,{„Q„� <br /> ciTv sTarE �-- ziP � 1 <br /> CONTRACTOR PHONE: �� � GONTF�ACTOR EMA{L• '` � ,��3 <br /> �t'�NTf�A�T�Ft i��GENSE#{REQtf1R�q�t _ �"',�C, GITY C1!��1I�RET7 BtlStN�SS't.IGENSE#(RE�'tUIEtE[71� ��7"�� <br /> PRIMARY CONTACT: ❑OWNER CONTRA�Tt7R ❑oTHER(Please 5pecify) <br /> CONTACT NAME: � CONTACT PHONE: (.�.'�GJ 25� �� <br /> y�� CONTACT EMAIL: � � ,� <br /> � � �`#��1LDING P"��M11`AP�'L�1G+i�T1t�N � � � <br /> Existin Use of Buildfn : Contract Price of Work: � <br /> i�rapased Use of Buildin : Heat Source: ❑Gas Electric ❑Oiher <br /> 13uii�ing Typa: FR-Detached ❑5FR-Attached ❑D lex ❑lNuttl-Famll -#of Units: ❑Commercial �Industrial <br /> 7 pe of Prcr ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. �Si n ❑Sprinkler �Demolition ❑Chan e of Use <br /> t3ESC PTIfJN OF WORK: <br /> �����G�.c..�e... � a+��,cx�, Pi���-1-r�L �'r u��1�'�'�,. <br /> � <br /> ASS(?GIATED BUILDING PERMIT#(it applicablc�); <br /> MECHANICAL PERMIT APPLtCAT1t"!N PLtJMBING PERMN'i':APPLI�A'TIt1N <br /> Type of ProJect: New Addn qiteratian Repalr 7ype of Project: New Addn _Alteratlon Repalr <br /> #of <br /> �;��1!vf fixtsu•aa #of :�.tst a�flxton�3 #of _L13ct ot�lxtuY��r #of tisf of Ftrfirres _ <br /> Ftxtures FlxCUres �ixtwres Fixtures <br /> AIC—Air Handlin Units Neat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air Systems Unit h[a�ter Bathtub Urinal <br /> Gas Piping Brail�r Lavatory(Wash 6asin) Drinking Fountain <br /> Water Heater Refci �ratl'on Shower Floor Drain <br /> Gas Fireplace Woc�Stove Kitchan Sink&Disposal Grease Trap <br /> Gas Range buctin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medicai Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mopletc. Other: <br /> SPRfNKLER/SUPPRESSIQN SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this applicalion and confirm the!n/amation contained herern is true and conecf. Woik done pursuanf to/his permif must comply wilh <br /> current(ederal,sfate,and local lew. The granting of e permit only aufhorizes approved woik and no deviations therefiom.Devlatiotts mus(/l�sf be aulhorized in writing lrom the <br /> Building Officiel before being authonzed under any circumstance.1 am fhe owner,or!am euthorJzed by the owner ol fhJs property to perform the work lor whrch appllcaffon is rnade, <br /> and i comply with the Sfafe Contracfors Law P8.27 RCW and 296.200A WAC. <br /> City of Everett Officia!Use Only <br /> PERMI 1 / ^ <br /> � l V <br /> Ow erlAutfiorized Age Signature Dale (Revise 9lF3I2pt&) <br />