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PERMIT APPLICATIOf� <br /> BUILDIN(�CHANICAL/ PLUMBING /SIGN I I�RINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 95201 <br /> (P)425-257-8810 � FAX425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue.�or Black Inl�c Only�lease)':� ��,; �:.P�ROJECT SITE�NFORM%1TI;ON�� �# :� ��: ,;� _� �,.�; .�� <�; �� �� <br /> .. � �. �.� � _x .. _ . .. ��., �_. �.. , <br /> PROJECT SITE ADDRESS: /2 �S �• SGU (3(/�r�� CU�-`I$�3 PROPERTY TAX#: 2$�'E lrLOo 3 GSoap <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> �.- <br /> CONTACT INFORMATION� � <br /> �. <br /> OWNER NAME: �J iNe�Neryw�sl� � , P v�✓ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s�EET 2'j?.v Gy'�/�oY'►1�G� <br /> ciTv I�1�►^`� STATE (N IA�- zia ��?if7( <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; (�'I l/D 6ih�GS <br /> CONTRACTOR ADDRESS: srReeT ��(�lp �O,S`� W L�SdL� e"�t - <br /> cirr �v�ZL� STATE �� ziP �$Z�j3 <br /> CONTRACTOR PHONE: (�O� �I�j"7— Z�j CONTRACTOR EMAIL: ..S A�Ov� C �'�rtGp�w�, kyt�,GS.G,,,�,�, <br /> CONTRACTOR LICENSE#(REQUIRED): GG? '"(��COG�, $$(o(t$ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 9�S?22. <br /> . ,- . ..,. : .,_„ v_.. .. <br /> .._. . . . ___ , .�_.. _ . . � e �__.._ � � .� �- �, .v �_ ._... _, �. �_ ,� _�.._� ��� __ �� <br /> PRIMARY CONTACT: OWNER ❑(s�ONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ��ZS �?�....G,(D� � <br /> �Ct1/� JG t/�S�t/L CONTACT EMAIL: G{,2...j�tv�,g2v. G� Sitin PuGI •Goyv. <br /> ;�. � '�" ,. �.' ' ;BUILDING;PERMIT�APRLICAT�ON�,' ,� ':� .�, �. � ;; y,; � ��, <br /> Existing Use of Building: Contract Price of Work:$ �V ��1� <br /> Proposed Use of Building: Heat Source: as ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ` ommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler emolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �ywo vt�� o�' �W�j -F°'`r �y�V��1�k�"G'� ��I Y�I,�1.$-�r� c u'�'yvs!� (1� 4 C�l� �11l��rX,— <br /> lV�ill7llL ��� '�r Pww.�t�-Pt� - v� t0ont38Z3 S��J✓�S 7c /L�MP«J� <br /> ASSOCIATED BUILDING PERMIT# if applicable : OY`G4�✓' Wo. <br /> MECHANICAL PERMIT APPLICATION`<,' ,:- PLUMBING P,..ERM1T�APPLIC�TION , <br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fi�rtures #of List of Fixtures #of List of Fixtures #°f List of Fiutures <br /> Fi�ctures Fi�ctures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Seroice/Bar/Mop/etc.) Other: <br /> _� �: ,. <br /> SPRINKLER/SUPPRESSION $YSTEM ,;' <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed fhis app/ication and confirm the information contained herein is irue and correct.Work done pursuant to ihis permit must comp/y with . <br /> current federal,state,and/oca/law.The granting of a permit on/y authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building O�cia/before being authorized under any circumstance.l am the owner,or/am authorized 6y the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only '•-r,. <br /> 5 ���i� PERMIT� l.�V���7 � <br /> Owne thorized Agent Signature D te (Revised 9/23/2016) -'' <br />