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. � � <br /> PEi� IT�PP�iCA►T10N <br /> BUILDING I MECHANICAL(PLl1�BIhIG f SIC;N f SPRINKLER J DEMQLI�'EUN <br /> CITY OF EVERET i"PERlNIIT SERVICES <br /> 320a CEDAR STREET, EVER�TT,iislA 98241 <br /> (P1 A25-267-8810 � �AX�325-257-8857 f(E3 everstteps@evere#�ra gou J www.everettwa.gov/perms`ts <br /> Btue or lack ink �nl Plea��� P �J�G'F �iT� t F ,�TIO <br /> PROJEG7'SITE ADDRESS: � � �� ,��''�,� � PROPEliTY TAX#: <br /> �'� trt�, <br /> LEGAL for new canstructian: Shor[PiaUsukdivision Lot No. (att�ch copy of lang legai descripii�n) <br /> i <br /> � C�NXAC'a`�'A1+1��� TI� <br /> I <br /> OWNER NADAE: � �� � TENAWT NAME{3f Commerciai}: �� <br /> � QWNER�AA1LitUG ADl3RESS: srr�Eer�` � � �� �� L.'�` ��`,'�;�,: <br /> cirv �"�� s1.a?r ����� zi^ �'�,��1�,�� <br /> i <br /> awnaEft��c��v�: ����� ` `•�r_ _� �a' }� ovvn���� oi: V � :°��; l� �"���� .�f� � ��;��:�`�� <br /> corar�aac-€Qt��vAtw�: �: �,c' , � f ;� °��"�" � �� ;� l� �=� ��l%� <br /> i CONTRI�CTURAQDRESS: sr�eEr ��i'" Z: F�' I'� .��,r�� ���.' ���� <br /> � <br /> ! C,iTY �,F 5 �r. 6 �9+jr�y ,� r . <br /> �" SL�.7E �+ � 2iP�`��.f � <br /> Go�-rR���oR pHora�: ��` ��� �-�~����-�,� cta��rr�c-�r����n,ae�= � ����� � � ���,����� � ����� ����C� ; "����� <br /> ' C06UTRP.CTQR�fCEldSE#(REQUiRED): ��� � f �;�1 ""��'���.°`�` ��� CITY QF EVEREl7 BUSINES&L►CEP+}SE#(RE4UIt2E j: �..� �; � <br /> PRIMARY CE3PtTAGT: ❑OWNER €�;C�PS�fRACTOR �OTHER(Please 5pecify) ti <br /> CONTACl"NAME: �C1MTA�GT�1°9C5NE_ �'�`��� ����~�.�� �� <br /> � <br /> � � � ��. ���� � �c��TA����,��. �j`�.,�; F� .as�" �' , �,��_.�.��F° ��°� <br /> � su'La��� ��r�n��-r���►`t�arwc�� � <br /> iExistin Use of Bufiding: Contract Arice ofi Wark:$ � <br /> ( Proposed Use of Buildin : fieat Saurce: ❑�aa Electric C?ther <br /> � Buildin T p�: l�SFR-Detached �SFR-Attached ❑Dupiex ❑Multi-Facnii -#ofUnits: Cl ommercial ❑irsdustriaS <br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair ❑T L ClSi n ❑Sprinkier � �on ❑Change of Use <br /> DESCRfPTIQN OF WC3RK: ,'�it�f������`� ��6' ����� ����� G� ����.%`�'`�'�� �'���_�`{��� <br /> ASSC7CiATE�BUILDiNG PERi69tT# i'a iicabie}: <br /> ��CHANICAL PERMIT QPP�.�CATION RLt6�fl��l�G �ERP+�1'T�i�3�LICATI�� <br /> Type ot Pro�ect: New _ Addn A#teracion €2epair Typ�of Pro}ect: _New �ad�n �Alterafion Repair <br /> #caf #af #of #vf � <br /> i Lisf of�r�tiureS List af FizfureS Ldsf of FixtuF'e5 List c�f�i�ures <br /> �ixtures Fixtures Fixtures Ftxture$ <br /> AIC—Air Hand€ing Units Heat Purnp T�ileY Backflow Prevanter{Inside Bidg} <br /> � �orced Air S}�stsms Unit Heater Bathtub Urinal <br /> � Gas Piping Boiler Lavatory(Wash Basin} Drinkin �oun,�irs <br /> � V�fater Heater �2e#rigeratdan �.�„ Shower �iaor Drain <br /> Gas Fireplace V�Jc�t�d Stnve Kif�hen Sink&Dis�snsa{ Grease Trap <br /> '�as Range �ucting Dishw�sher- Rnof Dra4ns <br /> Ciothes Dryer Hookups Other. c;lothes Washer t+�edic�l�as <br /> � Ranye Hood Water Neater Other: <br /> ;Exhaust Fan Sink(Service/BaelNEop/etc. Qther <br /> s ; � �����suR�R�ssr�►w s�rs°r��r <br /> � Chemical or Water No.of Meads <br /> ACi<NOWLEDGCMLNT:!have reviewed fhis app/icaYion and confirm fhe informatron contained herein is true and corrrct. Work dons�ursuant to this perm�t must ron�ply uvith <br /> ', current federal,state,arid tocal law. The grantutg o�a permit o�+ly au7frorrzes zpproved work and rro deviations therefrom.Deviations must frrsi oe authorizeti in avriting from the <br /> ', 8wlding�fflciai betore herng aufhonzed under any circumstance.1 am the o�n�ner,or!am autrtorized by the owner of this properfy to perforrn the work for whrch application is made, <br /> ; and t comply;vrth the State Coriiractors Caw i8.27 RCW aild 296.2QOA fNt1C. <br /> r City af Everetf O(ficia!1�`se Unly <br /> f PE <br /> ��,° � ��., � ,����� �,� ��� € '����{�' ��" — O Q <br /> Ownsr/Authorized Agent Signatuee Date (Revised B/23.�2016) <br /> �._ <br />