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Sep 26 2017 11;47AM Washington Wa��eatnrs 8663757454 pag�'� <br /> PERMIT APPLICATION <br /> BUILDiNG !MECHANiCAL!PL.UMBING ! SIGN! SPRiNKLER! DEMOLf7tON <br /> ci�rY or-�v���rr���Mir s�avic�s <br /> 3200 G�DAR STREE7,EVERE71',WA 98201 <br /> {Pj 425-257-B81 Q � FAK 425-257-8857 �(E}everettepsQevereliwa.gav� www.everetlwa.govlpertniis <br /> Blue or Black lnk Only Please) PROJECT SIT�INFORMATION <br /> PROJECT SITE ADDRESS: �(} � -N� {—� � PROPER7Y'CAX#: I LTI�iu� � D <br /> LEGA�far new conetrucHon: Short PlaUsubdivision Lot Na. � (attach copy of long legal description) . <br /> CONTACT IPIFORMATION <br /> .--- <br /> OWNER NAM�: � • l� THNANT t3AM�(tf Camrnercfal): <br /> OWNER MAILIAIG ADbRESS: sra�r ZU C�v i �t <br /> CfTY 9TATE (N�" Zip � <br /> OWNER PiiONE; OWN�R�NlAIL: <br /> CON7'RACTOR NAME; GU�51�i ti�tTT7�N � YZ ���"��S <br /> CONTRACTORADnf2�SS: STREE7 r�i5 Z. � [/� �1� �` Ux /G+� <br /> CI'f'! �� 9TA7E �� 21P <br /> CpNTRACT�R PHONE: Z J'" — CON7RACTOR EMAIL: � �L� CUrh <br /> CONTRAGTQi3 i.IGENSE#�REQUIREQ}: rj(,��y� $d CiTY OF EVERETT BUSlNE9S LICENSE#(REQL]fRE�J: ,3 <br /> PREMARY CONTAG7: ❑OWNER CONTRACTOR ❑O7MER(Please Specify) <br /> CON ACT NhME• CONTACT PHONE: '�.�� �—��"r <br /> V�( �u�1�`�i� C�NTACT EMAp.: G(f�f-�Ifl�jf�.l'�. �R'�''f(.,,t,�f� <br /> BUILDlI�t3 PeRMIT APPLICATION <br /> Exisfin Use of Buildin : -P l' �'('f Contract Price of Work•# <br /> Propassd Use of 6u U � Heat Source: I�Gas ctric ❑Other <br /> Bulidin '�y e: F -Detacned OSFR-Attached ❑Du lex I�ilAuiti-Famil �of Units: OCommercial ❑lndustr(a1 <br /> T pe of Project: ew DAdditian ❑Remodel ORe air ❑r.i. Ds� n OS rinklar C7Demolitfon C7Chan e of Use <br /> flESCRiPT1�N OF WORK: � , <br /> �'�f',�� ►r-� � f2-���_C-� � �._�_.� . . Gu�c.�{-�r c���-�� <br /> AS50C(ATED SUILDING PERMIT# if a liceble: <br /> M�CHANICA!PERMI"i'APP'I.ICATIOMI PLUMByNQ p�RM1T APAI,ICATION <br /> 7ype of Project: ,,.,"New Addn ____Alteratian �Repair Type of Project: New ,_,,,,Addn _Alteratian ^t2epalr <br /> �°f Lisi of Fix2ures #°f Lfsi ot�xtures �°f Ust of FixfuYes �°f tist of F7xtr�res <br /> Fixtur'�s Frxtures Frxlures Fixtures <br /> AIC—Air Handlin Units Heat Pump Toiiet BackBow Preventer{Inside Bld <br /> Forced Air S stems Unit Heater Bathtub Urina1 <br /> Gas Piping Boiler Lavato Wash Basinj Drinking FauataEn <br /> Water Heater Refrigeretion Shower Flnor Orein <br /> Gas Fire lace Wood Stave Kitchen Sink&Dis osal Greasa Trap <br /> Gas Ran e Ductin Qishwasher Roof Drains <br /> Clothes Dryer Haokups Other: Clothes Washer Medical Gas <br /> Range Hood Water Mester Other. <br /> Exhaust Fan Sink{ServicelBar/Mo letc. Other: <br /> • SPRINKL�R/SUAPR�SSION SYSTEM <br /> Number of Heads <br /> RCKNOWLEDGEMENf:l heve rev'ewed Mis apptkallon and conNrm thaln/onnatbn con�alned hereM is Irue a�M correct Work done pursuant la th/s pemfrf must comp/y witA <br /> currenf federel,state,and locnl law The granting of a permtl only eufNorizes approved work arrd no deviafians fhere/rom.DevlaUons mvs!firs!be authorized In writing from the <br /> Bulklinp Ofieelaf before being auFhorizsB unoter any Clreumstanee.!a+rF'R!e owner,a!am suthorized by Ihe owne�pt th/s property!o peRarm Ihe work ior whiCh appncation is made, <br /> ond 1 compry wlfh Mo Slate Contrscfors Low 78.27 RCW and 296. AC. <br /> - ' t Cify Of Everett�fi7G8!Use Onty <br /> +' / f `�—�" f ��J✓ � ���•�" PERMIT# � �� <br /> � _ � - - l � r « a � <br /> orlAuthorized Apent Signature Date (Ravised5J2 �7016) <br />