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PERMIT APPLtCATiON <br /> BUIL.DIN�ECHANICAL/ PLUMBING /SIGN /�INKLER 1 DEMOLITiON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FPJC 425-257-8857 �(E)everetteps@everettwa.gov� www,everettwa.gov/permits <br /> {Blue or 91ack Ink Gniy Plessej PROJECT SITE INPORMATION <br /> PROJECT SITE ADDRESS: �p 7d G'�✓'dQ 50�} � PROPERTY TAX#: ��� d�D 6�a( �'Q� <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal descriptlon} <br /> CONTACT INFORMATIQN <br /> OWNER NAME: ryt b Y'�L !�, � � � L TENANT NAME(If Commercial): $Ct W��, <br /> OWNER MAILING ADDRESS: srREer a g r� �D D*h S't'- s j�tJ <br /> ��� � e r e STA� j�.1�, �P y�'�0 �f <br /> OWNER PHONE; OWNER EMAlL: <br /> CONTRACTOR NAME; � �f" D�/j �Q�"'r� `�"5� io e e. � G <br /> CONTRACTOR ADDRESS; sTREEr /' O `�,5� �- a{' ,3 I 3 �sr ✓e f�� <br /> CITY ��� � �1I C/'�s STATE �� ZIP p��jr� <br /> CONTRACTOR PHONE: a S�-,�,3 S- a�D CONTRACTOR EMAIL: ir l I/�f 40'1 Y1�0. /Yi L T(�Ovt i�1r; <br /> CONTRACTOR LICENSE�t(REQUIRED):fQ I(y' tT Tr C� CITY OF EVERE BUSINESS LICENSE QUIRE�);3 � <br /> PRIMARY CONTACT; ❑OWNER L7 CONTRACTOR ❑QTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a s- �'�s" a a"7 <br /> ��LL►Z � �. V/Q Ci..l!`2 S CONTACT ENIAIL: �r'�' �'�� � ��a-�-�`� � r-� ���,. <br /> BUILDING PERMIT APPLICATI N <br /> Existin Use of Buildin : (�,�/' 6 � ,j Q 12 � Contract Price af Work:; /.� <br /> Proposed Use of Building: ,SG�YY1 Q_, Heat Source: as ❑Eiectric ❑Other <br /> Buildin Type; ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of Project: ClNew ❑Addition �Remodel ❑Repalr ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> - e x�`�e.h � �..A�S' i ��n '�a �R.t�c�.. b��.� u P e n e r'e��o k <br /> p �R <br /> - r�. �.d���► �o wt�[ � �- a.� �� � <br /> �' <br /> ASSQCIATED BUILDING PERMIT# if applicable : <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERM[T APPLICATION <br /> Type of Project: New _ Addn Alteratlon z,Repair Type of Project: _New Addn Alteratlon �Repair <br /> Fixtures U�of Fixtures Flxtures �st of Flacfures Ff�u es �st of Fixtures Fhctures ust of Fixtures <br /> A/C-Air Handling Units Heat Pump Toflet Backflow Preventer Inside Bldg) <br /> Forced Air S stems Unit Heater Bathfub Urinal <br /> Gas Pipin Boiler Lavato Wash Basin) Drinking Fountafn <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ftange Ducting Dishwasher Roof Drains <br /> Ciothes Dryer Hookups Ofher: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink Service/BarlMopJetc, Othe�, <br /> SPRINKLER l SUPPRESSION SYSTEM <br /> Number af Heads <br /> ACKNOWLEDGEMENT:!have revrewed thls application and confirm fhe Jn(amation contalned herein is true and correct.Work done pursuan(to lhis permrt musf comp(y wKh <br /> current iederaJ,s�afe,and local law, The grantrrrg o(a permR only authonies approved work and no deviafions fhere(rom.Daviations mus!iirst be authorized in wrlting(rom the <br /> Buildrng ONkla1 before being authorized untier any crrcumstanCe,!am the owner,or 1 am authorized by the owner of ihis property to perlorm the wak/or whlch applrcation fs made, <br /> and!comply with the State Confractors Law 18.27 RC W and 296.200A WAC, <br /> Clfy of Everett O�cral Use Only <br /> �EB6d1Z# <br /> lAuthorized Agent Signature Date Revised�20/2016) <br />