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PERMIT APPLICATiON <br /> BUILDING /MECHANICAL/ PLUMBING i SIGN /SPRINKLER 1 DEMOLITION ' <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FfUC 425-257-8857 �(E)everetteps@everettwa.gov� �w✓w.everettwa.govlpermits <br /> - - PRAJECT SITE INFORMAT►ON ,. <br /> _ <br /> PROJECT S1TE ADDRESS: . PROPERTY TAX#: ; <br /> '�JO�� S� �U�'(t'"�} I'�C.E <br /> LEGAL for new consfruction: Short Plat/subdivision Lot No. (attach copy of Iung fegal description) <br /> . ; ,_ �. � 'CONTAC'T INFORMATION � ` <br /> � <br /> OWNER NAME: }-(� TENANT NAME(If Commercial): ""1�''�e,S <br /> OWNER MAILING ADDRESS: sTaEEr <br /> cro sTnTE zi� <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: r r t��C.'i� '�V�CC-J i <br /> CONTRACTOR ADDRESS: srReEr � � �� �' - - �.r . T �tl !�Z � � <br /> /� �]�% /� � j <br /> CITY � I � (���_ STATE V�/rl ZIP /C�(/I I <br /> CONTRACTOR PHONE: yZS, : � C).�IIDL� CONTRACTOR EMAIL: .I����'S K,y�5' r.��(Y1SJ"l CL'+1'1 � <br /> CONTRACTOR LlCENSE#(REQUIRED): g ��j� CITY OF EVERETT BUSINE:SS LICENSE#(REQUIRED):�S� I U � <br /> __. _._,__. _. � _ __ _ _ � <br /> PRfMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: COt�1TACT PHONE: i.f�5 3"7,(;; �'•r f� ' <br /> � <br /> '�I(,i17� �7Cs1")Z4.:t�� CONTACT EMAIL: J 7�jr"S�C?): C,'315i �CC�i' i <br /> _ _ _. _ _ 't. <br /> = BUILDING PERMIT APPLICATION = ` <br /> - _ _ ,:- ';_ . " - , <br /> � <br /> Existing Use of Buiiding: �' �1'1 Contract Price of Work:$ E' V. �J � <br /> Proposed Use af Building: ;� Heat Source: ❑Gas ❑Electric ❑Other j <br /> Buiiding Type: ❑SFR-Detached ❑SFR-Attached ❑�uplex ❑Multi-Family�of Units: ommercial ❑Industrial ` <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ign ❑S rinkfer ❑Demolition ❑Change of Use " <br /> DESCRIPTION OF WORK: f <br /> Ii�5t�,11 (;�) L� G.k�a1\ �1��r1 �t�s�"���y c>t� r�i���,:���� � <br /> ASSOCIATED BUILDING PERMIT#(if applicable): � <br /> � <br /> MECHQNICAL PERNfIT APPLICATION - PLUMBING°PERMIT APPLICATION j <br /> Type ..__. __ .._ _ _ _ _ <br /> of Project: New _ Addn _Alteration Repair Type of Project: rtew Addn Alteration _Repair � <br /> #°f List of Fixfures ��f List of Fixtures #°f List of Fixtures #°f List of Fixfures <br /> Fixtures Fixtures Fixtures fi�ures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal _ <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain �, <br /> Water Heafer Refrigeration Shower Floor Drain � <br /> Gas Fireplace Wood Stove Kifchen Sink 8�Disposal Grease Trap � <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Ofher: �, <br /> Exhaust Fan Sink(Service/Bar/Mopletc.) Other: '; <br /> •- _ _ - : <br /> SPRINKLER/SUPPRESSIQN Sl(Si'EM.: � <br /> _ - _ _ - - __. _ __ : <br /> Number of Heads '; <br /> ACKNOWLEDGEMENT.l have reviewed this application and r.onfirm the informafion contained he�ein is frue and correct.Work done pursuanf fo fhis permit must comply with I� <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from fhe I! <br /> Building OSicial before being authorized under any circumstance.I am fhe owner,or 1 am authorized by the owner of this prope�ty�to perform the work for which application is made, � <br /> and l compl 'fh the Stafe Contracfois Law 18.27 RCW and 296.200A WAC. <br /> 1 l City of Evereft Official Use Only h <br /> � (1�,7 (� PERMIT#r , ', <br /> �`'L._ ��j. i��(.J L-' � � � r i <br /> �.7 L �J ��i <br /> O nerlAufhorized Agenf Si nature Qate (Revised 10/12/2095) � <br /> __� i+ <br /> /� r <br /> � r <br />