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PERMIT APPLICATIO <br /> BUILDINC�IIECHANICAL/PLUMBING /SIGN�PRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everetfinra.gov� www.everetiwa.gov/perrnits <br /> �_, <br /> (BIu�:or B#�ck Ink 3C�ly Pfea�e) F!�tOJEGT�SIT�1i�F4i�1�AAT10M, < ; ; <br /> PROJECT SITE ADDRESS: 5F �J¢,/¢�" (M4I � � I PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONT/tCT IN�t')RM�1TfON <br /> __ <br /> OWNER NAME: TENANT NAME(If Commercial): � o� i�j� �„ 'v�„�.�,. <br /> OWNER MAILING ADDRESS: SiREET � � � �l�—�c1 � ! <br /> CI7Y � STATE �" 21P V <br /> OWNER PHONE: Q � (p^ �(� �' OWNER EMAIL: <br /> CONTRACTOR NAME; .QD� ,�� <br /> CONTRACTOR ADDRESS: STREET I� a �� � r JY� <br /> CIiY l� Y(�/(�DOC� STATE W � ZIP � OZ� //� <br /> CONTRACTOR PHONE:�'(a� —SG - �n�( �" CONTRACTOR EMAIL:��Q �C�S 't�vla CCJ� <br /> CONTRACTOR LICENSE#(REQUIRED): � Q(p(Q (�� CITY OF EVERETT BUSINESS LICE SE#(REQUIRED):�a(Q� c(:b� <br /> : -, _ . .. .. <br /> PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR �OTHER(Please Specify) �T � d►� <br /> CONTACT NAM� CONTACT PHONE: �a� .. �Z� � t� (�"3 <br /> �.2y� ��� CONTACT EMAIL: (.QiYV ' �y � �i.H„ <br /> 'BtlN.DING'���RN11T APPLIGATIO,N _ <br /> � .. _ �_ . _ r <br /> Existing Use of Building: Contract Price of Work:$ t��C� <br /> Proposed Use of Building: a� V�Cc Heat Source: �Gas ❑Electric DOther <br /> Buildin Type: ❑SFR-Detached ❑SFR- ttached ❑Duplex ❑Multi-Famil -#of Units: �Commerciai ❑Industriai <br /> T pe of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air �T.I. ❑Si n ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> .��s�-� I( ��-r�. o� L�� ���� � ` �I��.�� I�,�s �� � r��w <br /> � �ja �o � ��k�S <br /> ASSOCIATED BUILDING PERMIT# if applicable: � <br /> MECHANICAL;PERM1'1`APPLICATION , . PLUMBING, PERMIT.APPLICATION <br /> Type of ProJect: _New Addn Alteration _Repair Type of Project: TNew Addn _Alteration _Repair <br /> #of tist of FPxtures #of ust of Flxtures #°f Llsf of Fixfures �°f tist of Fl�ures <br /> Fixiures Fixfures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> �.SPRINKLER/,,SUPPi�ES�iION;$YSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein is true and correct Woric done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviafions must first be authorized in writing from the <br /> Building O�cial before being authorized under any circumstance.1 am the owner,or I am authorized by the owner of this properfy to perform tne 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 O�cial Use Only - <br /> ,(/�c���� PERMI�- (� �V I <br /> � a \J� � <br /> OwnerlAutho�zed Ag Signatur Date (Revised 9/2 312 0 1 6) <br />