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BUILDiNI��IECHANICALE P�LUMBING�51GN 1 �!'RINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> E 3200 CEDAR STREET,EVERETT,WA 982Q1
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everefteps@everettwa.gov� www.everettwa.gov/permits
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<br /> PROJECT SITE ADD ,, PROPERTY TAX#:
<br /> Vr v_e,r� G.��1 q�
<br /> LEGAL for new consfruction: S ort Plat/subdivision Lot No. (aftach copy of long legal description)
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<br /> OWNER NAME: U .� �M fE�(Q,r��.,�- TENANT NAME{if Commercial):
<br /> OWNER MAILING ADDRESS: STREET �� �{'��` c�
<br /> CIIY -�`\ STATE W � ZIP � V
<br /> OWNER PHONE: t'F Z'� _ "Z� "- �.S OWNER EMAIL: G J� Z I� C c'� • c.��.
<br /> CONTRACTOR NAME: �r""
<br /> CONTRACTOR ADDRESS: srReer
<br /> CIN STATE ZIP
<br /> CONTRAGTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR I.IC�NSE#(REQUIRED): GITY OF EVERETT BUSINESS LICENSE#(REQUIRED}:
<br /> PRiMARY CONTACTc' I�:QWNER I�60NTRACTOR ml�OTHER(Please Specify)
<br /> CONTACT NAM': � CONTACT PHONE: uZ - 'Z�p? - ��L
<br /> � f'\C r� � CONTACT EMAIL:
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<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> 8uilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New C7Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTfON OF WORK:
<br /> . yr�J.J��t ' (�rt"�vt (�r� ��S �
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> ..� �:..'_`ME�HAN ' � �:.����.:. ....,,P�.UMBYN:G PERMIT APPLI;CATr�N.`::�:.;.� s� �
<br /> . .,.....;..:...:._ ICAL PERMMT�APPLI6A''TION.:..��:;:�.;; �:.. :::-��:-.
<br /> Type of Project: ,_New� Addn _Alteration ^Repair Type of Project: �New Addn Alteration _Repair
<br /> �°f Lisf of Fixtures #of Lisf of Pixtures #of List of Fixtures #of L.ist of Fixtures
<br /> Fixtures Fixtures Fixtures Fix#ures
<br /> AtC-Air Handling llnifs Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bafhtub Urinaf
<br /> Gas Piping Boiler Lavatary(UVash Basin) - Drinking Fountain
<br /> V1later Heater Refrigeration Shower Flopr prain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Ctothes Dryer Nookups Other. Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> F�chaust Fan Sink(Service/Bar/Mop/efc.) Other:
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<br /> ;'�;':;::;:.'.;:SPRINKLER:;l:;;SUP�PRES510I�7�:SY$T�M;...':.:��::`
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.�l have reviewed fhis application and confirm the information contained herein is trwe and correct.Work done pursuant to this permit must Comply with
<br /> current federal,state,and locallaw.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must firsf be authorized in writing from the
<br /> Buiiding O�cia!before being authorized under any circumstance.1 am the owner,or l am authorized by the owner of fhis property to perform fhe work for which application is made,
<br /> and I comply with the Stafe ontractors Law 98.27 RCW and 296.200A WAC
<br /> � Cily of Everett O�cial Use Onfy
<br /> � �� � PERMIT# O� ���
<br /> Owner/Authoriz gent Signature
<br /> Da e (Revised 10/1 2095)
<br /> � 5���
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