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PERMIT APPLICATION
<br /> tNC ECHANICAL /PLUMBiNG / SIGN ! II�INKLER! DEMOLITION °°
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 32Q0 CEDAR STREET,EVERETT,WA 98201
<br /> ' jP�425-257-8810 � FFiX 425-257-8857 ((E)everetteps a��verettwa.gov( wwv,r,everetivva.govJpermits
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<br /> ��tu�or B�ack Ink QM' P[ease}_ PROJECT SITE INFORMAT�ON
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<br /> PFvQ;��G"f'�tt`�•�7������; �"t()(D �J� CGPJ� S� �V�C'f W�R ZO PROPERTY TAX#: �C , �/ 00�00 oZ/ Q .,
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<br /> LEC"sAl.for new construcYi�r: 5hart Platisukciivis�c3n _ tat Now �� (attach co�y of lang lag�i description)
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<br /> CONTAC7I.NFORMAT�ON '
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<br /> OWNER NAME: __ '� , �, , �„�, TENANT NAME([f Commercialj:
<br /> C'��1ER MAILING ADDRESS: srRE�r �'1 �� ` d'E
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<br /> C!7'Y 5T'A7E �w ZIP ���2� ,
<br /> &}1�t1��R PHONE: '�i i�.�,''+I�I' �." ' OWNER EMAIL.,:c�1UlQL�Pa . 1,�. " �I :.
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<br /> CQNTRACTOR NAME. .(iO+� .'.' `.. �ST�NF . t�i�N(,�" /,l�/'�,.,,
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<br /> CONTRACTOR ADDRESS: srReeT I7G�'�C /tT�� .,�i�'r.� �j�, ;OI� ,,
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<br /> cjrY c�7�"'/� L.L- s-ra-re �it�f�- r..�� 9�/' ,
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<br /> Gt���'FtAC''t`L}R:PHONE: ,��5= +�'i��- `'} CONTRACTOR EMAIL: ;" :. �",j� ,}�lC�3,�'�X�i'3��..C�✓r) ;
<br /> �ONTRACTOR LICENSE����'L11RED): eQ� .�=1'„�,�,� CITY OF EVERETT BUS{NESS LICENSE:�l���T]$RE1g�.° O.3',�"`�t
<br /> PEt1M�4F2Y''CONTACT: �OWNER CC►�'EONTRACTOR ❑ OTHER(Please Specify)
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<br /> GONTACT NAME>,; CONTACT PHON�; �t���-°_�/�,Q�$"..rp�/� '
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<br /> cSAQ�4 GOR/V15�, oF�/f� rY1ANAGF'� c�r���Y Enna���,� ��r��'��'�,�!`��c.o�xr ,
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<br /> BU�LDING PERMIT A�PLIGATION
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<br /> ��ti�r� ;Use of Buildit� . �� Contract Price of_Work�:$ �/,��?.�O
<br /> P�q �a�ed Use af Buit�t� ; Heat$ource: QGas ❑Electric 04��ter_
<br /> ��1�`�c,�„��3�, ��.��¢{F FR-Attached ❑Du 1e�. ❑Mufti-Fami »#of Un�#�, ❑Commercial ❑Industrial
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<br /> }�of�'rs�j�cf; �New [,�Addition ❑Remadel �e�3r ❑T.1. Q��g� C}� ►�rtik��r ODemolition ❑�,tr� �of Use
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<br /> DESCRIPTIdN OF WORK::' : __ _ _
<br /> �t.r'1r10t1�E..�'►'��i�-ic9►'`- '�..�1�2.�(atsL W' C�6'Tv�dQ4�'�+�. �-�0.C� PW �'1'�-��.. ��.��°t��r�tL�
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<br /> t�k��d�IATED BUILDING PERMIT# k� . ��ble� _._ __ _ �i.YY�Q Od��Vi2-&S �S �'16�l.A
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<br /> MECHANICAL PERM�T APPtICAT10N PWMB�NG PERM�T APPLtCAT�ON
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<br /> Type of Project: �New _ Addn _Alteration _Repair `Type of Project: _New _Addn _Alteration _Repair
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<br /> #ef #of #o! __ #of _
<br /> Lisf of Fixtures tist of Fixtures List of Fixiures tist of Fixiures
<br /> Fixtures : Fixtures Fextures Flxtures
<br /> " A!C—Air Ha�dling Units '' Heat Pum� ` 7'oilet Backflow Preventer(inside 81d } "
<br /> Forced Air Systems Unit Heater ' , ;° Satht�ti' " Unnai
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<br /> Gas Pi in '' 8oiler
<br /> ',Lavatory{Wash Basin) '' Drinkin Fountain `
<br /> Water Heater ' __. Refri eration �hower: " Ftoor Drain . ;
<br /> Gas Fireplace _. Wood Stove ;Kitchen. Sink&Dis osal ;; Grease Tra'
<br /> Gas Range . Ductin pishwasher ° l�ooP Drains;
<br /> Clothes D er Hookups, . i Other: Clotfies Washer Medical Gas
<br /> Ran e Rood ' 1Nater Heafer Other.
<br /> Exhausf�an Sink{Service/Bar/Mo letc,- , Other.
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<br /> SPRINKtER/SUPPRESSION SYSTEM
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<br /> : AGKNQWLEDGEMENT.�f have reviewad this application and con�rm the information contained herein rs frue and correct�Work done pursuant io this permit must compty with
<br /> current federal,state,and locat law<_The granfing of a permit only authorizas approved work and no deviations therefromm Deviatiorts musf�rst ba authorized in writing fmm the
<br /> ' Buihiiny Officiat before being authorized under any circumstance;;t am lhe owner,or I am authorized by the owner of thrs propeMy to pedorm the work for which application is made,
<br /> " and!comply with the Siate Contractors Law 18027 RCW and 296$ZOOR WAG„
<br /> �t'��n(Everetf Q�c.rc�/Use f�'f�"
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<br /> Cft��r rfi�i'pri��d Agent Signature : _ __ Oate __..� (Revised 5I2G/2�16) _
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