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��' � ��-�� T��`������'�� <br /> �.�� PERMIT APPLICATIO� <br /> �.: <br /> BUILDING ! MECHAPIICAL/ PLUMBING / SIGN / SPRINKLER i DEMOLITION <br /> CITY C?F EVERETT PERMIT SERVICES <br /> 32Q0 CEDAR STREET,EVERETT,WA 9&201 <br /> (P)�25-257-�510 � FA?t 425-257-5857 �(E)everetteps@everettwa.gov� wv�v.everettwa.gov/permi?s <br /> (Blue or Black Ink Onty Pleas�) �1t�.9ECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: � �i� �'% � �� � 'c� '"���1 e�- !'1�'1� ���C L� PROPERTY TAX#: <br /> LEGAL ror^aw constn:�ticn Shcrt PlaUsuCdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �,�L'„�-��= i;,�� ,-� ��"L' e}`}� ,�l •� t-} TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReeT <br /> CITY STATE Z�P <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ���( � - � � ' I�� �� CC.�I`li���� ' I Y <br /> CONTRACTOR ADDRESS: srReer J /V � � 2-� <br /> CITY � I STATE Z�P �V <br /> CONTRACTORPHONE: �ZS' � -G'� CONTRACTOREMAIL: Q�'� 1n�1 Li F� t��' � 1'� <br /> CONTRACTOR LICENSE#(REQUIRED):�L L�����}j 'f'1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: �OWNER �CONTRACTOR ❑OTHER(Please Specify) � <br /> CONTACT NAME: CONTACT PHONE: �Z� - 7L .- � 7`7 <br /> �C���� G� � CONTACTEMAIL: �,�1�1�£C �'� e_c` j-��-�' C ,'�'�Y'3ZLt� I- CGiy� <br /> BUILDII�lG PERMiT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work:$ 'b _'� ' 3 <br /> Proposed Use of Buiidin : Heat Source: ❑Gas ❑Electric OOther <br /> Buiidin T pe: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Famil -#of Units: ❑Commerciai ❑industrial <br /> T pe of Pro'ect: ❑New OAddition ❑Remodei ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> j—u�,-��,� ��c�c�e�-����L%� ��j-� ���c�l�1c�-���>� � <br /> ASSOCIATED BUILDING PERMIT#(if a licab�e): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICQTION <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures ��f List of Fixtures #�f List of Fixiures #�f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A�C-Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> � Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin Boiler Lavato (Wash Basin) Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Firepiace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ducting Dishwasher Roof Drains <br /> Clothes D er Hookups Other: Clothes Washer Medicai Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mo letc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No. of Heads <br /> ACKNOWLEDGEMENT:I have revie�ved this application and con/irm the information confained herein is true and correct Work done pursuant to this permif must comply with <br /> �: current federal,state,and loca!law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> _` Building Ot�icial before being authorized under any circumstance.1 am the owner,or f am aufhorized by the owner of this property to perform the work(or which application is made, <br /> � and I comply with the Slate Cont�actors Law 18.27 RCW and 296.200A WAC. <br /> '� City of Everett Offrcial Use ONy <br /> �; ,�- � PERMIT# <br /> � Qwner Auth - ____ _ ��� I r �� ���I �� �.� ���� <br /> �, onzed Agent Signature Date (Revis2d 9/23/2016) <br /> �' <br /> �" <br />