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P�Rmrr,aP�Lrc�-rid�W <br /> BUILDING / IVIECHANICAL/ PLUMBIIVG /SIGN /SPRINFCLER/ DEMOL.ITION <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.gou/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> ROJECT SITE ADDRESS: � �`7 GO'1�� l4`�� ���I I PROPERTY TAX#: <br /> LEGAL for new construction: Short Piat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> � OWNER NAME: t'V�O�,q,ro i J�G� nJ�Qp N.S 5 OG- TENANT NAME(If Commercial}: ���t�i.Qi P�N��� <br /> OWNER MAILING ADDRESS: srReer ,3 L("Z j— G�l�$`� /�`r� <br /> crrc �'`r��� STATE j�A, ziP �$' j <br /> OWNER PHONE: � .�-�`� �..-�� Q�7 Z� OWNER EMAIL: <br /> CONTRACTOR NAME; t,�y S P�5pNS pQ�1N <br /> CONTRACTOR ADDRESS: s-rRee-r �.-"� �, • .D � ySI <br /> ��7y N(�' � {/1� �S STATE . ��- ZIP �y�� <br /> CONTRACTOR PHONE: �a ,�-^�j'�f ��o� CONTRACTOR EMAIL: p�J tS �i't?J��-C1JS oN„�/�QfJ�' (�d✓►1 <br /> CONTRACTOR LICENSE#(REQUIRED): v�$��I(p�' �JV- CITY OF EVERETT BU5INESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: OWNER �CONTRACTOR ❑OTHE ease Specify) 'T�J�S �+t��.tGu�c4"� <br /> CONTACT NAME: / CONTACT PHONE: ��� � �(� g- �"1�'7 <br /> ��J�S �'��`'�'�� CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: N'�-v Contract Price of Work:$ ��. �o� - ��' <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family�#of Units: �7Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkier ❑Demolition ❑Change of Use <br /> �DESCRIPTION OF WORK: <br /> e n s t�r� nf�� pv�. ✓��►.�L �w a-�-C, <br /> ASSOCIATED BUILDING PERMIT#(if ap licabie): <br /> MECHANICAL PERMIT APPLICATION PWMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures Lisf of Fixfures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units t Pump Toilet B flow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub rinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Dispos Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer okups Other. Ciothes Washe Medical Gas <br /> Range Hoo Water Heat Other. <br /> Exhaust n Sink(Se ice/Bar/Mop/etc.) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the information contained herein is true and correct.Work done pursuant to this permif must comply with <br /> current federal,state,and loca!law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be aufhorized in writing from the <br /> Building Official before Being authorized under any circumstance.l am the owner,or l am authorized by fhe 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 <br /> � . PERMIT# i1'� j\r ��� <br /> 1J ::� <br /> Owner/Authorized Agen ure Date (Revised 9/23/2096) � <br /> � <br />