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PERMIT APPLICATIOI� <br /> BUILDING / MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govtpermits <br /> Blue or Si�►�k 1nk`O„1 Pleas±�) Plitt'�JE�'y"SITE INF[�RMATION <br /> PROJECT$ITE ADDRESS: (�D Z. C. � �yQ� �V4�- �43�tr� PROPERTY TAX#: <br /> GAL for new construction: Short P�aUsubdivision Lot No. (attach copy of long Iegal description) <br /> CONTACT INFORMATIQN <br /> OWNER NAME: ��s� Q�s TENANT NAME(ff Commercial}: <br /> OWNER MAILING ADDRE5S: STREET (j PJ Z C PsE �ttc� <br /> CIN �/,�(}(,(�C.�"� STATE ZIP �Q'S'ZQ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAMEc {�V(> > <br /> CONTRACTOR ADDRESS: STREET Z�j CO� <br /> CITY .� STATE ZIP g (J` <br /> CONTRACTQR PtiONE: �L'S � - (,�z CONTRACTOR EMAII,: � � �c..f,o✓''1 <br /> CONTRACTOR L10EN3E#(REQUIRED): (�L �'Z CITY OF EVERE7T BUSINESS LICENSE#(REQUIREd) � <br /> PRIMARY CONTACT: ❑OWNER ■CONTRACTOR �OTHER(Please Specify) <br /> GONTACT NAME: CONTACT PHONE: '� T 2 <br /> �/j ;i�� � Ct�NTACT EMAIL. <br /> BUILDING PERMIT APPLICATI�N <br /> Existin Use of Building: � e. . Contract.Price of W :$ �d� <br /> Proposed Use of Buiiding: tr �. eat Source: ❑G s ❑Electric Other <br /> Buildin Type; �lSFR-Detached ❑SFR-Attached ❑Quplex ❑Multi-Family-#of tlnits: ClCommerciat ❑Industriai <br /> T e af Pro'ect: ❑New l�Addition ❑Remodel ■Repair ❑T.1. ❑Si n �S rinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WQRK: rc�,,a F� ��K��� r�-� <br /> A5SOCIATED BUILDING PERMIT# if a licabte : <br /> MECHANICAL PERMIT A�'PLICATION PLUMi31NC3 PERMlT pPP1.�CATiON <br /> Type of Rroject: _New Addn Alteration _Repair Type of Project: _New _Addn Alteration Repair <br /> #oF �ist of Fixtures #�f Lfst of Flxtures #of i�st of Ffxtures #°F LisE of Flxfures <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 Pi in Boiler w°s^ '� Lavator Wash Basin Drinkin Fountain <br /> 1Nater Neater Refri eration Shower Floor Drain <br /> Gas Fire lace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Ctothes D er Hookups Other: Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink{ServicelBar/Moptetc.} Other: <br /> - SPRINKLER/SUPPR�SSNQN SYSTEM <br /> Chemieal or Water No.of Heads :'� L �' <br /> ACKNOfNLEDGEMEMT;!have reviewed this appticafion and con8rm the informafron coniained herein is true and carrecf.Work done pursuarrt to this permit must comply with <br /> currerrt federat,state,and tocal iaw.The granfing of a permit only authorizes approved work and no deviations therefrom.Deviations must first ke authorized in writing from the <br /> Buildirrg OfTicial before being authorized under any clrcumstance.I am the owner,or I am authorized by ihe owner of this property to perform the work for whtch application is made, <br /> ar+d 1 crompty wifh the State Contractors Law? 2 C nd 296.200A WAC. <br /> C!ry of Everett O�cral Use Only <br /> `Z I ' �� I� PE� # ` �"�- 'Q�. <br /> Owner(Au hori ignature Date (Ravised 9/23/2096) <br />