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PERM{T APPLICATION <br /> BUIL.DING/MEGHANICAL/ PLUMBtNG/S[GN/SPRINKLER/DEMOtIT10N <br /> CfTY OF'EVERET7 PERMI7 SERVECES � <br /> 3200 CEDAR STREET,EVERETT,WA 982Q1 <br /> (P)425-257-8810 ( FAX 425-257-8857 �(E)everetteps@everettwa.gov� wwvr.everettwa.gov/permits <br /> _ .,.:. .: . ;. <br /> ` � _ „�' RROJECT SlTE::IN�ORMATION � :; - ' " <br /> PR0,IECT SITE ADDRESS: { PROPERTY TAX#: � �� <br /> LEGAL for new construction: Short Plafi/s bdivision Lot No. (atEach copy of long fegal description) <br /> . _: ..., G <br /> > ,,'.. _,. ..:: .,;. . - . -.:' .;� ,':CONTACT IN:�aORMATION�' .. ._...;: . � ,:: .. , .,. „ „.w,�,,.'. <br /> OWNER NAME: � � TENANT NAME(If Commercial): <br /> . <br /> OWNER MAILING ADDRESS: srrteer � � �- � + �S <br /> CffY ^�"' STATE ZIP <br /> OWNER PHONE: ,�.p —� OWNER EMAIL: <br /> .............. ... ......... . . ......... _ ............ .. . . .... ......... ... ......... ____..... .._.. , ............_... _._........... . ...... _ <br /> COIVTRACTOR NAME: �j C (�„C <br /> CON7RACTOR ADARESS: sTReer <br /> cirr srn� ziP <br /> CONTRACTOR PHOfVE: -�-53 —30� — �¢��. CONTRACTOR EMAIL: MSk O �/. �» ' <br /> CONTRACTO}2 LtCENSE#(REQUiRED): CC �A CITY OF EV€RET7 BUSINESS LICENSE#(REQUIRED <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR J�OTHER(Please Specify) j <br /> CONTACT NAME: CORITACT PHONE: ,4�� _ 3� -- Cj(�..� ' <br /> [� O� CONTACT EMAIL: S�� ��� � <br /> _. ,. �. <br /> ` � �. BUILDING;;PERM.I..,T,APPLiCAT10N � ' ' ' <br /> Existing Use of Buiiding: 8 $1 d Contract Price of Work: �.� <br /> Proposed Use of Building: �✓( � — $ � Heat Source: ❑Gas �Electric ❑Other <br /> Buiiding Type: OSFR-Detached ❑SFR-Atfached ❑Duplex ❑Multi-Family�#of Units: Commercial ❑Industrial <br /> T pe af Project; ❑New �Addition ❑Remodel ❑Repair ❑T.I. ❑Si n �S rinkler �tion (�Change of Use � <br /> DESCRIP710N OF WORK: Z" S-f`� � <br /> C�eVho � l-F ho� �aGi'r';r. �•v�t[i �-aY � <br /> i��o � ��f G,. r��.,� aMcd no �x--F�r�v+-- t���/ oa-, s`r �ke H?o�;�°�`, <br /> r� �. G�� <br /> ASSOCtATED BUILDING PERMIT#(if apphcable): <br /> ,r ME�HQNiCAL 1�ERM�T APPL1CATl_O,,,N .,.,. ;... , '. ; ., . ..;`PLUMBING PERMIT,APPLICATION ��2, :�: � �;`.,':'�t..."s � <br /> y <br /> Type of Praject: „_New _ Addn _Alteration „^„Repair Type of Project: _New _Addn Aiferation ,_„Repair <br /> #°f List of Fixtures #of List of Fixtures �°f List of Fixtures #°f List of Fixtures � <br /> Fixtures Fixtures Fixtures Fi,�ctures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Prevenfer{Inside Bidg) <br /> Forcad Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) �rinking Fountain <br /> Water Heater Refrigeration Shower Ffoor Drain <br /> Gas-Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher : Roof Drains <br /> Clothes Dryer Hooku s Other: Clothes Washer Medicai Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Qther: <br /> _,;SPRINKLER%SUPPRESSI,ON SYST�M;, ` „' � <br /> Number of Heads <br /> ACKNOWLEDGEMENT.-!have reviewed this applicafion and confirm the informafion contained herein is frue and correct Work done pursuant to fhis permit must comply wifh <br /> current federal,state,and local law.The granting of a permif oMy authorizes approved work and no deviations fherefiom.Deviations must first be authorized In w�iting from the <br /> Building O�cial before being aufhorized under any circumstance.l am the owner,or!am authorized by the owner of fhis properfy to perform the work for which application is made, <br /> and l comply wifh the Sfafe Contractors Law 18.27 RCW and 296.200A WAC <br /> p Cify ofEvereff Official Use Only <br /> y _ � PER T�l_ I V � J D �/ <br /> pT (/•- 7.c�� <br /> OwnerlAu orized gent Signature Date (Revised 10/12/2095) <br /> l <br />