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PERME�'APPN�@G�A,�'ION <br /> ' BUILDINC�ECHANICAL / PLUMBlf�G I SlGN �RINKLER / DEMOLIYION <br /> CIT`(OF EVERFTT FERMIT SERVIC�b <br /> 3'LOU C�DF1R STREET. F'��ERFT7.WA 98201 <br /> (P)�325-257-8810 � FAX 425-257-8£35l �(E)everet:eps�iileverettwa.gov� www.everettwa.gov/permits <br /> � PROJECT SITE INFORMATIOAI <br /> �'ROJECT SITE ADDRESS:Z3�s �Q�Q/1 �T PROPERTY TAX#: �S,�P�U�/D2��� <br /> �.�rGAL for new construction: Short PlaUsubdivision/�/9UN7��fj�/�S ay 1.Lut No._Z_ (attacn copy of fong legal description) <br /> �� CQNTACT INFORMATiON <br /> �ilWNER NAME: �G�jd ,�/GS � � LG G TENANT NAME(If Commercial): <br /> �tiU'JNER MAILING ADDRESS: sTRee� ���D7 /UfL �/ T� Sj, ^ /9jJT �'i <br /> ' ..._.v. CIIY /C I/C/'�` �/VKJ _� STATE / ZIP �(/C��3 <br /> (:�ti'VNER PHONE: Z�y - /�T'.3��3 OWNE12 EMAIL: /�1 �li!/2 /y)� �70 f'y/a ' � G(Jy�� <br /> Cr�NTRACTOR NAME COGL�j/S�Z,qT��/� ��,�57/�CT/� Q/U��G��/U� C� <br /> CC)NTRACTOR ADDRESS: srREEi �p¢Z2 �Q S 7��`U��� <br /> ---•----- crrv /�C/�C��-�3/viC/ __. srnre G'I/!'/ ziP /l/��� <br /> E:OMTl�l1CTQRPHONE: 2G�- (�/ —/�Z�- ;CON'Tft,0.CTOREMAIL: Q(/CL���'� -Q'���'� �f'x C�/j'� <br /> !:�ON7�ZAGTOR LICENSE�(REQUIRED): �D�L� �C/ ��p�� CITY OF EVERETT B�ISINESS LICENSE#(REQUIRED): <br /> ?'F+�NiARY CONTACT: ❑ OWNER ❑ CONTRACTOR �L4f�T�HER(Piease Specify)_ iU�S�G/!�/i 2 <br /> �:.fiE�1TA�T NAME: �:UNTAC'T PH(2N7�=: ZQ�p_�S2 _ 9Z¢`� �� <br /> lil//LG/fj�/Iil �OTTG/�.�j CUN�s�!C� ENiAI L:GjjI�J d// !/c��0 !q/�O/��� /� <br /> � BUlL.QIWIG PERdil11T�lP6'LICL\TIOP! <br /> ¢�:f:!tina Use of Building: ��� Contract Price of Work: $ /2�Pi 3�� <br /> 'ryrc,posed Use of Building: �fje Heat Sou�ce: ❑Gas Gd�lectric ❑Other <br /> ,;%ui!:;i��g Type: FR-Detache ❑SFR-Attached ❑Dupiex C]Multi-Family-#ef Units: � ___ ❑Commercial ❑Industrial � <br /> l ype ot Pro ect: ❑New ddition �emodei ❑Repair �7T.1. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> i�ESCRIPTION OF WORK: �,�NO�yT� /��%S�/�U(j- LcJ2 �f 2 /�/�J /BA/��SiUi�ivCF� ��i�iiti�7/�cJb- <br /> ��.� .� �T� ,�,� �� �4o s�= ,�,��,,-,o,� �,;� 2,�2, Z/�A f�J C�U�u,cY'y ,�d� <br /> �9it�o .�JCsG ,�D 35 .�fi C�l�iz2/�.� .�02«�J�J 2�l> �� 6,�,�iu D/�c/� <br /> :�i:i�JCfA;�"FD BIDILDING PERMIT#(if applicable): <br /> ���� �l1ECHANICAL PERMIT APPLIC�7g(3�l � P'�.�Bb1BIhIG �ERM9'�APPLICA710N <br /> fj/�e of Project: _New _ Addn _Alteration __fiepair � Type ut F'roject: ,__New �Ac�n ✓Alteration _Repair <br /> ����F #of � ~--- <br /> rixrvres List of Fixtures Fixfures List ot Fixtures #�f List o3 Fixtures #of List of Fixfuies <br /> Fixture�� Fixfures <br /> 4 ,,� A/C-Air Handling Units Heat Pum� �� 2 -foilet �� Backflow Preventer(Inside Bld�) <br /> WM_ Forced Air Systems Uni:Heate=M �v Bathlub Urinal <br /> _ Gas Piping Boiier Z Lava?ory(V!Jash Basii�} � Drinking Fountain <br /> M Water Heater Ftefrigesation _ / _ Sho�n,�er Floor Drain � <br /> _ Gas Fireplace INood Stove � I �i Kitrhen Sir�k&Disposal • Grease Trap <br /> Gas Range Durting / Dishwash�r Roof Drains <br /> / Clothes Dryer Hookups Othe�: / Cluthes 1,�VasFie; Medical Gas <br /> � f Range Hood - Other: <br /> R LL�. Exhaust Fan v! _ � _ S nk (Se��ice;E3ar�Mo�/etc. Other: <br /> M SPRINKLER/SUPPRESSION SYST�IIH <br /> �� Number of Heads <br /> ,4C:�CNO�iVLrDGEMENT:I have reviewed this application and confirm ihe in(orme;iorr cartai.ned hereir.�s true carrd correct. Woric dune pursuant to this permit musf comply wi'h <br /> ci:rrent federal, s te,and loca!law. The granting of a permi'orly au'horizes��pprovrd work c�nd no ciaviations there6rom.Deviations must first be authorized in writmy from the <br /> F>uildi.�r�Officia efore being authonzed under any circurnstanr.e.I am the owner,or I am.�ulY;c;�zed!�y iLe owrn>�r af this property to perform the work for which application is m,ade, <br /> 2nd�cnmply ith the e Contractors 18.27 RCW and�96.2UGA WAC. <br /> Cify of Everett Official Use Only <br /> �� � PERMIT#, i . -���-' <br /> C ��� a� o� ��%�� ��1 l�C�I' �,-�� <br /> t�w�ner/Authorized Agent Signature +� D� e � �� (fZevised i0/1212015) <br /> � ` L �. <br />