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� � <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERcTT PERMIT SERVIC�S <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 ((E)everetteps@everetri:�a.gov� �v��nv.evereth�,2.gov/permits <br /> (Biue or Biack!nk Qnly Please) PROJECT S�'FE fi�FORMA't'ION <br /> PROJECT SITE ADDRESS: � �-i G � � ��j- ��1"- �;,- PROPERTY TAX:�:,^ � �� j � ,�� <br /> � <br /> ,t l� I i^ r'Vi_%C,C: , ..C� <br /> LEGAL fc r,ew c;�s;ruaicr S^or.P!aJsuCdivisice Lot No. (a:tach copy o;:crg legal desc�ip,ion) <br /> G�NT�kGT t�d�S3RMd,Ti�ta <br /> ;, � <br /> OWNER NAME: 1���..�,�-j ,-J v+c�C;,�,�`i� TENANT NAME(if Commercial): <br /> OWNER MAILWG ADDRESS: s��eer S 1-I `�y I,��- c��� Lt� <br /> cir. L t/�v'�`r--F- sr- �i�/� zi= C��v?G.S <br /> OWNER PHONE: L+�S- �5 -�j- -I 3�"f J OWNER EMAIL: /j/�/� <br /> CONTRACTOR NAME: /v� fr1,A�T�;,�j�j{�� S , �L <br /> CONTRACTOR ADDRESS: ss�e- j ??�,�� ( �-� �V-� �� <br /> crv � 1 i t�� � s-,�r C.L'1'� z:� �'1�Z z� <br /> GONTRACTOR PHONE: ���-y�� c:�j y 5 CONTRACTOR EMAIL: �j/�,�.{�j-(^����•S�' r:�,;,,-�'�,C�;� <br /> CONTRACTOR LICENSE TM(r2EQUIRED):�/ui t?��f j�Q --S�y� CIN OF EVERETT BUSINESS LICENSE'�#{REQUIREDj: � � (?�� <br /> PRIMARY CONTACT: �OWNER �CONTRACTOR ❑OTHER(Please Speci"ry) <br /> CONTACT NAME: CONTACT PHONE: �(�� . �5-3_ �---1 3 '�7� <br /> .-, <br /> '-� ' — <br /> t 1C�d i:1 ;/ �Tch �i-�v'1`,�,� CONTACT EMAIL: ��- <br /> /V'; <br /> �UILDlNG PERMIT APPl.tGA'tiON <br /> Existin Use of Buildir,o: Contract Price of Work:5 `��� <br /> Proposed Use of Building: Heat Source: BGas ❑Electric ❑Other <br /> Buiidin Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Family�#of Uni±s: ❑Commerciai ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel �Repair ❑T.I. ❑Sigr ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: �� <br /> id Lt�1�Z� 41���#-'�:'-.. I � �_s ��c -r ��:t�— �!�e�.+c: i..c.,.� �., r. <br /> i�'�.���„ � <br /> '!%�'>1 �L <br /> ASSOCIATED BUILDING PERMIT:.(if applic�ble): <br /> MECHANICAL PERMIT-APPLICAT[�At PlUMBtNG PERMIT APPLICATICIN � <br /> Type of Project: _New _ Addn _Aiteration �_Repair Type of Project: _New Addn Alteration _Repair <br /> ;�of List of Fixtures ��f #of <br /> Fixtures Fixtures List of Fixtures Ff�ures Usr of Fixtures List of Fixtures <br /> Fixtures <br /> A!C-Air Handling Units Heat Pump Toilet Backf(ow Prevenfer(Inside Bidg; <br /> Forced Air Systems Unit Heater Bathtub Urinai <br /> G2s Piping Boiler Lavato <br /> I Water Heater ry(Wash Basin) Drinking Founiain <br /> Rerrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposa( Gr2ase Trap <br /> Gas Ranga Ducting Dishwasher <br /> Roof Drains <br /> Clothes Dryer HooRups Other: Clothes Washer Medical Gas <br /> Range Hcad Watar Heater Othzr: <br /> Exhaust Fan Sink(Servica;Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSlON S1fSTEM <br /> Chemical or W2ter No.oi H=ads <br /> ACKNOWLEDGEIrcNT:1 have reiiE:�ey tnis appl;c2!,'cn and co.oiirm th.e rnfo;rnaticn con,ained narein is true artl CCrrecL V✓ork done pursuznt to thrs permit must comply�vdn <br /> currern federal,s:a:e,ar,d loca!lav.t The graniing of a permA on/y autnorizes approve��vor'K and no deviations?heretrom.Daviations mus!first be authorized in wrdrng from tne <br /> Burlding Glficial befor�being authaized under any circumstance.1 am tne o�me�,ot!am aw,hcnzed by th.e��me�of this p�operry to pe�form Ghe,vork for��h;ch applrcation is made, <br /> and 1 comply:vi.'h tne Sta!e Con!2ctors Lav 18.27 RCVY antl 296.200A V/AC. <br /> Crty of Evar2tt Oficial Use Only <br /> ? PERMIT#�„ � � �� <br /> �` �L'"�o - i ���� I D� <br /> n,.,.,...i��..ti....,..a�c,._� _ <br />