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PERMIT APPLICATION <br /> BUILDING/MECHANICAL i PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> .__ _ <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.gov/permits <br /> (Blue or Biack#nk Only Please) PROJECT SiTE INFORMATION <br /> PROJECT SITE ADDRESS: a t(�D �jt�^qyo( /['V e PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description} <br /> � <br /> CONTACT INFORMATtON <br /> OWNER NAME: �' yv�.g,r,5 �/!c<,���C2�- Ll.,G., TENANT NAME(If Commercial): � �tiJ�.�c ¢- GG <br /> OWNER MAILING ADDRESS: sTaee-r O O�^7�� C� R�'�Ci.Jo� 7!J(� <br /> CI7Y STATE V ZIP "^J�Q <br /> OWNERPHONE: 70� -� - (�j OWNEREMAIL: �S�Er �eb S l�a,� . �oh <br /> CONTRACTOR NAME: �j,�' /N1� vi ca L PG <br /> CONTRACTOR ADDRESS: srrzeer Q,'� i'� e �/� /�Gt� <br /> CI1Y �, �+ STAIE (.J/�} ZIP g,3 '3� <br /> CONTRACTOR PHONE: 2.S 3— 2.Z`(-- O S CONTRACTOR EMAIL:f�y.���Q,,,,�aC j � h ,Cor� <br /> CONTRACTOR LICENSE#(REQUIRED): ��{'y S W!y/�I� �O GS CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): I�`�(�{ <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR �OTHER(Please Specify) �� � <br /> CONTACT NAME: CONTACT PHONE: ,�5 3^,��.�'I`"�XD EiS <br /> 7:w, C�/c <br /> CONTACT EMAIL: 71-;,,,,�SNnec.Gt4.hi�G,L � G MS.ti.c.o <br /> ' BUIf.DIN�PERMIT APPI.ICATION ' <br /> Existin Use of Building: Contract Price of Work:$ �z �C.Y�e� <br /> Proposed Use of Building: Heat Source: ❑Gas �Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Dupiex ❑Multi-Famil -#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New �Addition ❑Remodel �Repair �T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:��s��� p��`�Q� �Q`�_t N C����, fjOX L'S and a s.roci a-�/ refr;se��ai't <br /> / <br /> Sys�ew� S , =v►,s�i�at( re�'�;se�a�roh sxs�e� �or beveraSe. Ccnlers . <br /> ASSOCIATED BUILDING PERMIT# if a licable): <br /> MECHANICAL PERMIT APPLICATION ' > PWMBING PERMlT APPLICATION < <br /> Type of Project: �New Addn _Alteration _Repair Type of Project: New Addn _Alteration TRepair <br /> #of ��sf of Fiutures #�f List of Fnctures #of List of Fixtures #°f List of Flxtures <br /> Fixtures Fixtures Fixtures Fixfures <br /> A/C—Air Handling Units Heat Pump Toi(et 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(Service/BadMop/etc. Other: <br /> SPRINKLER/SUPPRESSION SY$TEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the information contained herein is true and wrrect Work done pursuant to this permit must comp/y with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefiom.Deviations must first be authorized in writing from ihe <br /> Building O�cial before being authorized under any circumstance.1 am the owner,or 1 am authorized by the owner of this property to perform the worlc for which application is made, <br /> and l comp/y with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Onty <br /> �.-�.' PERMIT# /� ��I� <br /> /.2- y—aoi7 � L <br /> erlAuthorized Agent Signature Date (Revised 9/3/2016) <br /> � � <br />