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F'ERMIT APPLICATION <br /> BUILDING/MECHANlCAL/PLUMBING/SIGN/SPRINKLER/DEMQLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (Pj 425-257-8$10 � FAX 425-257-8857 �(Ej everetteps@everettwa,gov� wwrw,everettwa.gov/permits <br /> (Blue,or Blacic'tnKON' P�ease) PROJECT SITE INFORMATION „ ' <br /> PROJECT SITEADt3RESS: ,�.� �� lj"C pROPERTY TAX#: (� � � � - <br /> LEGAL for newconstruction: Short Plat/subdivision Lot No. (attach copy of long legal desaription) <br /> �`" � - ���� � � GONTACT�I�IFORMA7I.ON� <br /> OWNER NAME: � -�, �-"" }��„j . TENANT NAME Qf Commercial): <br /> OWNEft MAILING ADDRESS: STREE7 2 Zp L�- �Ye� �'�"'S"" <br /> cirr ' '.- srnre z�P � '�,�)� <br /> OWNER PHONE: �r-�, � �� OWNER EMAIL: <br /> CONTRACTOR NAME: �, b ,, .-�- � ��y �„ _ <br /> CONTRACTOR ADDRESS: sraEET Ir��� ti "'C�y� (� � �` � <br /> . CI7Y ' STATE Y V �� �P �, � . <br /> CONTRRCTOR PHONE: �' ��� • CONTRACTOR EMAILs 1�� ��/,,�� �,,��y� .���a� <br /> CONTRACTOR LICENSE#(REQUIRED): � " ' �- CITY OF EVERETT 9USINESS LtCENSE#(REQUIRED);(�� <br /> PRIMARY CON7ACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) � <br /> GONTACT NAME: CONTACT PHONE; �.�-` ��f j� <br /> �•t <br /> ��.��� CONTACT EMAIL: �' dt/' �rl I`l} ' �����'�1 <br /> , <br /> f' BUILDING.,PERMIT APPLICATION ~ _ � <br /> , . r <br /> � ...�: :� � ,.�:. <br /> Existin Use of Buiidin : �a� � Contract Price of Work;$ �,.� <br /> Pro osed Use of Buii ing: � � <br /> Heat Source: ❑Gas lectric ❑Other <br /> Buildin T : FR-Detached ❑SFR-Attached ❑Du lex ❑Multi-Famf1 -#af Unitsi ❑Commercial ❑industrfal <br /> T pe of Pro ect: ❑New �Addition ❑Remodel ❑Re air �T.i. ❑Si n ❑S rinkler ❑Demolition ClChan e of Use <br /> DESCRIPTION OF WORK: <br /> �1�;� �1A.O'1� � �U�(:���2 v� •> <br /> ASSOCIATED BUILDING PERMIT# tf a licable: <br /> MECNANICAL PERM17 LICATION PLUMBING PERMIT ApPLICATION <br /> `= , . .; <br /> Type of Project: ,^,,.New_ Addn iAlteration _Repair Type of ProJect: �New _,Addn � <br /> #of ___piteration `Repair <br /> List of Fixtures #of #of #of <br /> F/xtures Fixtures LlstofFlxtures L+sf ofFixtures List ofFtxturss <br /> Fixtures Flxtures <br /> A/C—Air Handtin Units Heat Pum Toilet Sackflow Preventer Inside Bfd <br /> Forced Air S sfems Unif Heater Bath#ub Urinal <br /> Gas Pipin Boiler <br /> Lavato Wash Basin Drinkfn Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Pire lace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Ga5 Range Ductin aishwasher Roof Drains <br /> Clothes D er Hooku s Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Service/Bar/Mop/etc. Qther: <br /> ;,SPR�It1K4ER;/SUPPRESSION$YSTEM <br /> Chemicai or Water No.of Heads ' <br /> ACKNO l3EMElJT.•I have revtewed this appfrcation and conTirm the information contafned hereln is true and correcG Work done pursuant to this perrntt must comp/y with <br /> cu federa state,and local law.The granting of a permit on/y authodzes approved work and no dsvfatfons(herefrom.Devfeftons must Nrst 4e authodzed!n wr/ting from the <br /> B g Of/7cf befwa being authodzed under any c►rcumstance.f am the owner,or/am aufharized by the owner of th/s property to perform the work for Which app/lcatlon Is made, <br /> tl t ply the State Contractors Lew 18.27 RCW and 296.200A WAC. <br /> Clty of EvereK OHfc/a!Use Only <br /> `� pER r ` � _ � � <br /> V � <br /> O na uthoriz gent gnature Date (Revised 9/23/2096) <br />