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s � ' PEf2M1T'P►P1'L1CA7'101�! <br /> - �UILDiIVC�iECH.4,R(iCI�L I�'LUM�INC9 I SIG1\i I I�iINKLER I DEfIlfOL.l`CIOM <br /> CITY OF EVERETT PERMIT SERV(CES <br /> • 320D CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 42b-257-8857 �(E)everetteps@everettwa.gov� www.everetiwa.gov/permits <br /> (�lue or�Iack AnEx Oniy�le�se) I�RO.IEC7'S1'YE Iti�FORMA7`9�i�1 <br /> PROJECT SITE ADDRESS: 2 � ��.�'�' ��S PROPERTY TAX#: Z.GJI�S�I�JD� jP,� �CJG� <br /> LEGAL for new construction: Short Piat/subdivision Lof No. (attach copy of long legal descripfion) <br /> GOId7'/�C'A'I�dgORMATIO�E <br /> OWIVER NAME: ��� (�t,7�f �(;, �`(,�f�.}-�- , TENANT NAME(If Commercial): <br /> OWNER MAILlNG ADDRESS: srReEr C3 Vj �'Z <br /> Cm' �" �—�G � STATE W i/� ZIP ��' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: ��� <br /> CONTRACTOR ADDRESS: srReEr <br /> C�1Y STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR L(CENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �z J-- 'Z�"3 .. � j '��"� p y.i(„ <br /> ���'4"r'J � e..._`y=.}"_'��,. CONTACT EMAIL: ,}'�_G� • � ee ,�L! � • (5• <br /> BUILD[NG PERMIT APPLICATION <br /> Existing Use of Building: rv1� '�"S Contract Price ot Work:$ � � � <br /> Proposed Use of Building: , Sf�-a-v�� Heat Source: ❑Gas ❑Electric ❑Other <br /> Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family�ofi Units: ❑Commerciai ❑lndusfrial <br /> Type of Project ❑New DAddition ❑Remodel ❑Repair CIT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> � U ` • - - ��� ':..J "�C`''r�v� �. �a-, .. <br /> � �U 4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): .� �5�" <br /> MECHANICAL PERMIT APPLICATlON PLUMBING PERMIT APPLICATION <br /> Type of Projecf: _,New Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of �st of Fixfures #of List of Fixtures #of ��st of Fixtures #°f List of Fixfures <br /> Fixtures Fixfures Fixtures Fixtures <br /> A/C—Air Handiing Unifs Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater � Bafhtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kifchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clofhes Dryer Hookups Other Clofhes Washer Medical Gas <br /> Range Hood Water Heafer Other: <br /> Exhausf Fan Sink{Service/Bar/Mop/efc.) Other: <br /> SPRI[dIKLER/SUPPFtESS1AM SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.'1 have reviewed this application and confirm the information contained herein is true an'tl correcf.Work done pursuant to fhis permit musf comply with <br /> current federal,sfate,and local law.The granting of a permif only aufhorizes approved work and no deviations therefrom.Deviations must frrst be aufhorized in wrifing fr.om the <br /> Building O�cial6efore being authorized under any circumstance.1 am the owner,orl am authorized by fhe owner of this proper(y to perform fhe work for which application is made, <br /> and l comply wifh the Sfate Confractors Law 18.27 RCW and 296.200A WAC <br /> Cify of Evereft Official Use Only <br /> ` — .___,_.. Srr-- �� � � PERMIT <br /> ' �(�o�--�la <br /> Owner/Authorized Agent Signafure Dafe (Revised 9/23/2016) <br /> � <br />