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� . <br /> PERMIT APPLICA710N <br /> BUILDING /MECHANICAL/ PLUMBING/S1GN I SPRINKLER! DEMOLITION <br /> C1TY OF EVERETf PERMI'F SERVICES <br /> 3200 CEDAR SFREET,EVERE7T,WA 98201 <br /> (P)425-257-BB1� � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Black lnk Only Ptease) '' 'PROJECT SfTE IN�ORMATION - _ <br /> PROJECT SITE ADDRESS: 1�,-'} ��i� 'iCl�'a �.J��= ��1��C�"E'C'�f��I PROPERTY TAX#_ C}O�t,�Qj�j�j ��,SOO <br /> LEGAL for new canstruction: 5hort PlaUsubdivision^Y Lot No. (altach copy of long legaf des�ription} <br /> ,_ _,... <br /> - _ .. - . CONTACT INFORMATION .�: <br /> OWNER NAME; ���q,��v , ,�(��'�h TENANT NAME(If Commerciaf): <br /> OWNER MAILING ADDRESS: srr�e�r \ �� �/��r"';l` � ��f� <br /> . CRY ��I�C�C''�` STATE � ZIP '1 C�OI <br /> OWNERPHONE: y�..'�5���"-{��� OWNEREMAIL: <br /> CONTRAC70R NAME: i a\ �L�� �(�' p C. ,I�?I� . <br /> CONTRACTOR ADDRESS: sraEEr �("j);_-j� L- ��`�= �� •l.t� <br /> crrv �c 7 l`.i ��"C''C`� srn� (,�}-r�C ziP L�g L�S <br /> CONTRAGT�RPHONE: �_� „ .��� CON7RACTOREMAIL: (y��Ciu��C � ��`-�C� fQM <br /> CONTRACTOR LlCENSE#{RE4UIRED): �j�L 1���'�`G�C�V C�� C1TY OF EVERETT BUSINESS LICENSE#(REQUIRED): �j�j L� <br /> __.... . __ <br /> PRIMARY CONTACT: �OWNER �CONTRACTOR 0 OTMER(Please 5pecify) <br /> CONTACT NAME: CONTACT PHONE: (;,��_ Lt � S,�5� <br /> t��lCLn� ��C�C�`��g`\ <br /> CONTAC7 EMAlL: �a�`���G �I�.��-ed � �c�cri <br /> _ _ _ _ _ <br /> = ;' .: ` ':; BUILDING-PERMIT APPLICATION = ` ` <br /> ,..-_ _ . , <br /> Existin Use of Buildin : ContracE Price of Work:5 ��� � <br /> Proposed Use of Buildin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T e: ❑SFR-Deiached ❑SFR-Attached ❑Duplex ❑Multi-Famil -#ofUnits: ❑Commercial ❑Industrial <br /> Type of Project: �New ❑Addition ❑Remodef �Repair ❑T.I. ❑Sign C7S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> ASSOC(ATED BUII..DING PERMIT# if a licahle: <br /> MECHANICAL PERMIT APPLICATION `- " PLUMBING::PERMIT APPLICATlON -` `` <br /> Type oF Project: _Naw ,_ Addn ✓Alteration ,Repair Type of Project: _New _Addn _A{teration _Repair <br /> #of �of #of #of <br /> List of Fixtures L.ist of Fixtures Llst of Fixtures List of Fixiures <br /> Fixtures _.__ _ --- Flxtures .__... Fixtures Ftxtures <br /> -- <br /> - --- P_JG_Air_-NandRng Urllts =_= Heat Pump - ----Tailet— ----- -- -.--- . -------- BackflowPreveoter_Qnside_Bldg) <br /> __:-- - <br /> Forced Air S stems Unit Heater Bathtub nna ---��-��- <br /> ___. ____—..__.Gas_P_iping �q.iler ______..__._._Lavato Wash Basin Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplaoe Wood Stove Kitchen Sink 8�Dis osal Grease Trap <br /> Gas Range Ducting DEshwasher Roof Drains <br /> Clothes Dryer Hookups Other: Ciothes Washer Medlcal Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(5erviceJBarlMo letc.) Other: <br /> ;;SPRINKLER-/SUPPRESSION SYSTEM_ _' <br /> Chemical or Water No.of Heads <br /> ACKNOYVLEDGEMENT.�!have reviewed fhis applicafion and cankmr the in(ormatlon contained herein!s frue and correct.Wark dane pursuant to th/s pennit must compJy wrth <br /> cu�renf federal,state,and lacal law.The granting of a permit anly authorizes approved work and no deviatlons therefrom.Deviatiarts must rrst 6e authorized!n writrng(rom the <br /> Building OKcla!be(ore being authorized under any ci�cumstance.!am lhe owner,nr!am authorized hy the owner o/lhis praperty!o perform the wodr(or which application is made, <br /> and t comply with fhe Stafe Cantractors Law 18.27 RCW and 296.200A WAC. <br /> Ciry ol Evereft O�cial Use Only <br /> PERMIT � <br /> � � z. �z-�- r ��- 0�" � <br /> Revised 9 3/201 ) <br /> OwnerlAulhorized Agent 5ignature Dale ( <br />