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PERM{T APPLICATION
<br /> BUILDING / MECHANICAL/ PLUMBING /SiGN !SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 32Q0 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8814 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� wvwv,everetiwa.govlpermits
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<br /> �Iue or Black Ink �+!��a�, PROJ��T StTE�NFORMAT�ON
<br /> PROJECT SITE ADaRESS: '* : : PROPERTY 7AX#; � `
<br /> L�,C",��4L,for new construction: Short Platlsubdivision __�_�_��_�Lot No. {attach copy of long Iegal description)
<br /> . CONTACT INFORMATION
<br /> OWNER NAME: � , TENANT NAME�tf Commercial�:
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<br /> OWNER MAILING ADDRESS. '. s-rReer '
<br /> CIfY . .:.�: `. STA7[i . Zif�• ��
<br /> .. ._ . . ..... . . .... .. . . .._ . �
<br /> OWNERPHONE. p„- �j - 'Z OWNEREMAlL:
<br /> ��i�Tl�+iG�'Ol�:NAME: CD+� ` �`7'Z��1I;�` RGUF/N� 1�I�. ,.... _
<br /> �ONTRAGTOR ADDRESS: sTReeT I7'r/�y /d'"�'�
<br /> ��r� ��G� SLC °� ''OJ� _
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<br /> arv t�/ . L/C- s-rnrF �iQ�- zi� 9�/.Z
<br /> CONTRACTOR PHONE: q,?,�,'— ,8s— CON7RACTOR EMAIL, . ,�",,� �,��?,�',��.C,GYYj, I
<br /> CONTRACTOR LICENSE#(REQUIREC3): CO/EN -f�1�,�J,�`� Gl�1�OF EVERETT BUSINESS LICENSE�F�f+�t)[R'�D). D3;�`�t
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<br /> PRIMARY CONTACT: ❑OWNER C�'EONTRACTOR ❑OTHER(Please Specify}
<br /> CON7ACT NAMEt CONTACT PHONE �
<br /> ��Q� C'.OQ/1/16�, oF�iC� rnArvAG;E� GONTACT EMA1L: �.2c�'"'y�f'�T�—O/// NG
<br /> __ SRtQA� CA/RN�RcS7ZW{-�2Q7F� •Co/YI
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<br /> BU�LDING PERM�T APPL�CATION
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<br /> Existin Use of Building:SFR— ' > . Contract Price of Work:$ •
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<br /> Pro osed Use of Buildin : Heat Source: C1Gas ❑Electric ❑Other
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<br /> �ut�a��T �' �: �FR-Detached ❑SFR-Attached ❑C�t� t�� ❑M��ti»�rt►ii �of Unitsr ClCommercial ❑Industrial
<br /> �'yp�of f��Q#�Y. ONew ❑Additian ❑Remodel e �ir ❑T.1. ��i �i ��pr3nkler ❑Demolition �Char� e of Use Q�-�,�, '
<br /> DESCRIP710N OF WORK: �mOY'Q, ` �,� ��
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<br /> A�SOCIATED.BUILDING PERMIT#'it� :l�G�k�!!e.. - '
<br /> MEGHANiCAI. PERM�T APPLICATtON PLUMBtNG PE�,IT APPLICATION
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<br /> Type ofProject: _New A Addn _Alteration _Repair Type of Project: _New _Addn ____Alteratfon �Repair
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<br /> #of .' List of Fixtures #af tlst of Pixiu►es #�f List of Flxtures #of List of Fixtures
<br /> Fixtures ; Fixtures Fixtures' Fixtures
<br /> A/C—Air Handlinc�Units Heaf Pump Toilef Backflow Preve�ter: Inside Bldg}
<br /> :'Forced Air S stems Uni4 Heater Bathtub Urinal
<br /> ;�as Piping 8oiler ' Lavato Wash Basin Drinkin Fountain
<br /> ` Water Heater f2efri eration Shower �loor Drain `:
<br /> _,Gas Fire' lace Utlood Stove Ritchen Sink&bisposaf Grease Trap
<br /> Gas Ran e Ouctin ` Dishwasher Roof Drains
<br /> Clothes D er Hookups Other: Glothes'WasheF " Medical Gas
<br /> Ran e Hood Water Heater Other:
<br /> Exhaust Fan " Sink Serv�ceJ�a�1Mo teta. ; Other:
<br /> SPRINKLER!SUf�PRESSION SYStEM .
<br /> _ Number of'Nea s _ : .-
<br /> : ACKNOWLEDGEMENT.t have reviewed this application and confirm the infarmation confained herein is true and correct.fAlork done pursuanl fo this permit must comply with
<br /> ' curreni federaf,state,and locat law. The granfing of a permit onty authorizes approved work and no deviations Iherefrom,beviations musi�rst be authorized in wnting from ihe
<br /> S' 8uitding O�cial6efore being authonzed under any circumstance,1 am the owner,or I am auihorized by the owner of this property to perform the work for which application is made,
<br /> and 1 compfy with the State Contractors Law 18,�7 RCW and 296e200A WAC,:
<br /> Cily of EvereU O�cial Use�t���
<br /> _ P�IT#
<br /> �� � :.; �-.u,..�c. ��� '�",'2.p/� ' — ,
<br /> ��t�x�lu�f2ssx��[;Agent Signature : �� (Reteis�d�� i�J _
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