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PERMIT APPLICA <br /> BUILG i MECHANICAL i PLUMBING/SI /SPRINKLER I DEMOLITION <br /> ClTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT.WA 98201 <br /> {Pj 425-257-881Q � FAX 425-257-8857 �{Ej everetteps aQeveretiwa.gov( www.everettvwa.gov/permits <br /> {Blae or Biack Ink Only Please) " PROJECT SITE INfORMATION <br /> PROJEC7 SITE ADDRESS:' �� PROPERTY TAX#:;;�" ' ' �n�-' <br /> LEGAL for new constructian: Short PlaUsubdivision tot lVo. (aitach copy af long iegaf descriptioo) <br /> � CONTACT INFORMATION <br /> OWNER NAME: (�� i` � � �- w' TENANT NAME(If Commerciai): �- . '�- �� <br /> OWNER MAIUNG ADDRESS: s�er j��-�i p <br /> CITY C,,� . � � � � STATE ' ZfP � <br /> OWNER PHONE: . OWNER EMAIL: ' , �'►� d� �S,��L' ,��� <br /> CONTRACTOR NAME: � r i(��� �� -• �, a <br /> CONTRACTOR ADDRESS: • smt�r j'� � � <br /> �� IY�i` �V STATE �P ��G�i � <br /> CONTRACTOR PHONE: �i���«'�'�����`�i CONTRACTOR EMAIL: t �' ��jLt�f'�i� (.�VI r "�i� <br /> CONTRACTOR LICENSE#{REQUIRED):����� �'�i'�y{� CiTY OF EVERE7T BUSINESS UCENSE#{REQUIFLED):��"�'(y-`� <br /> PRIMARY CONTACT: �OWNER CONTRACTOR ❑OTHER(Please Specity} <br /> CONTACT NAME: CONTACT PHONE: �j +�i{- ''"� ,� L'� <br /> �1/I� .' ` Y�e�I���-�' CONTACT EMAIL: yt�I C;�C.�,C'. � � � ' ' <br /> BUILDING PERMIT APPLiCAT10N <br /> Existin Use of Buildin : "��j/ Contract Price of Work•$ A <br /> Proposeti Use of Buitdin : Heat Source: ❑Gas ❑Electric ❑Other <br /> Buiidi T : ❑SFF2-Detached �SFR-Attached �Duplex OMulti-Famii -#of Units: ❑Commercial ❑Industrial <br /> T of Pro'ect: L7New DAddition ❑Remodel ❑Re air L7T.1. Si n �S 'nkier ODemolition �Chan of Use <br /> DESCRIPTION OF WORK: �!,���i;�/C�'1 ��VA"�".`.�C��i•�. �j"�7�i�S�C,'Y`I� -j!�It�. tI�I�`�f}"�.L (;���"�� <br /> i.�i� i U:vt tvt i�t�rT� ir�-�,.�`t t3 f�t� � C D N V�GT To�ST1 N E'� t:��-Ci�t..T.ihTSTA�-� �`T'y C'� <br /> i" � ��C���T �t L�-N ��, . <br /> ASSOCIATED BUILDING PERMIT# if a icaWe: <br /> MECHANICAL PERMiT APPLiCAT10N PLUMBING PERMIT APPLICATION <br /> Type of Projeat: ,New _ Addn Alteration _Repair Type of Project: _New _Addn Alteration ,_Repair <br /> #of i.ist of Fixtures #of #of #of <br /> Ffxtures ��u�s tist af Ffxtures tist of Fixtures LisE of Fi�urr�s <br /> Frxtures ���5 s <br /> A!C—Air Handlin Units Heat Pump Talet 8eckflow Preventer Inside Bld <br /> �orced Air S tems Unit Heater 8a#htub Urinal <br /> Gas Pi in Soiler Lavat (Wash Basin Drinkin Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposai Grease Trap <br /> Gas Ran e Ducti Dishwasher R��p��� <br /> Ctothes D er Hooku Other. Clothes Washer Medica!Gas <br /> Ran e Hood Water Heater Other. <br /> Exhaust Fan Sink Serv�ce/Bar/M etc. pther: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT.•!have reviewed this apptication and co�rfirm the informafion contafrred hereln is true and correcL Work done pursuant to this permit must compty with <br /> � current federat,state,and local law.The granting of a permft oMy authorizes approved work ar+d no deviations fherefrom.Deviations must flrsf be authorJzed in wrlting hom fhe <br /> Bufiding Official before being authorized under any circumstance.I am the owne�or l am authorrzed by the owner of this property to perfam the work for which applicafion!s made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.2p0A WAC. <br /> City of Everett Official Use Onfy <br /> PE <br /> - i i3 � ���� - O� � <br /> Owned rized Agent Signature D te (Revised 9/23/2016) 1��l <br /> �/ <br />