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<br /> PERMIT APPL.ICAT�ON ;
<br /> BUILDING/MECHANICAL,/PLUMBtNG 1 S[GN 1 SPRINKLER/DEMOLITI�N �
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 9820'I
<br /> (P)425-257-88'Ifl ( FAX 425-257-8857 �(E)everefteps@everetfwa.gov� www.everetiwa.gov/permits
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<br /> �,--;>'� __,.�.� � . �:�.�,.,--PRt?JEGT;SITE.±INFORMA'TION,.._ _ - — - , - _ --- - -
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<br /> PRaJECT S1TE ADDRESS: PROPERTY TAX#:
<br /> 1.t,?C�. 3A
<br /> LEGAI.for new construction: Short Plat/subdivision Lot No. (attach copy af long legal description)
<br /> �, �� ti , r} -� � � � .� . 4�,�CONTAGT INFORMATiON � ? `��, ,i�, �-� r�,:
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<br /> OWNER NAME: � -�- TENANT NAME(if Commercial): �� �j-}- ���
<br /> OWNEF2 MAILING ADDRESS: srReEr
<br /> CITy STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: � SL i
<br /> CONTRACTORADDFtESS: sraEer � ,�i� -� �'�C�1=e` �
<br /> ��., STA� ;� Z�P a
<br /> CONTRACTOR PHONE; 'LI2�, CONTf2ACTOR EMAIL: "�"�1 'n Y�,
<br /> CONTRACTOR LICENSE#{REQUIRED): S � CIFY OF EVERETT BUSINESS LICENSE#(REQUIRED): "rJ5��
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<br /> PRtMARY CONTACT: ❑OWNER ONTRACTOR ❑OTHER{Please Specify) #
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<br /> CON7ACT NAME: CONTACT PHONE: �" Q , �
<br /> � 1(� �t� ��i 1�!.�+�.� CONTACT EMAlL: �j � �,SY7. �eT
<br /> � ��' i� n� � � r BUII..D,ING:P�.��MIT>APPLIC.'AT10N.;'�`� "-`� ,.,t�_ -
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<br /> Existing Use of Buiiding: Contract Price of Work:$ �J
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Elecfric ❑Other
<br /> Buiiding Type: ❑SFR-Detached ❑5�R-Atfached ❑Duplex ❑Multi-Family-#of Units: �ommercial ❑Indusfrial
<br /> T pe of ProjecY. ❑New ClAddifion ❑Remodel ❑Repair ❑T.I. ign ❑S rinkler ❑Demolition ❑Change of Use �
<br /> DESCRtPTION OF WORK: �
<br /> On�t-a�l �►) L� C�S�vm ��1 ��9�
<br /> AS50CIATED BUfLDING PERMIT#(if applicable):
<br /> __...__
<br /> ,_�;.���MECHXIN�CAL�PERM�Ti;APP�.ICATIt�N�...„�.,�`;; x� ..�.;,;. „ 1;;�:�,,,, PLUNl,BING;,PERI}IIIT�tAPPL�,CATION�.�.,�,�. 5��-"�`' �
<br /> Type of Project: ,_New_ Addn Aiteration _Repair Type of ProJecf: _New Addn Aiteration ,_Repair �
<br /> #°{ Lrst af Fixtures #�f List of Fixtures #of Lisf of Fixtures #°f List of Fixtures �
<br /> , fixtures Fixfures Fixtures Fixfures �
<br /> A/C—Air Handling Units Heat Pump Toilet Backflow Prevenfer{Inside Bidg) �
<br /> Forced Air Systems Unit Heater Bafhtub Urinal 2
<br /> Gas Piping Boi(er Lavatary(Wash Basin) Drinking Founfain
<br /> Water Heafer Refrigeration Shower Ffoor Drain
<br /> Gas Fireplace Wood S#ove KiEchen Sink&Disposal Grease Trap
<br /> Gas Range Duc#ing Dishwasher Roof Drains
<br /> Clofhes Dryer Hookups Other: Clothes Washer Medicai Gas �
<br /> Range Hood Water Heater Ofher: �
<br /> Exhausf Fan Sink(Service/Bar/Mop/etc.) O#her:
<br /> �``;���SPRINICLER=/SUPPRESSIO,N�'SYST�tVI� �' �
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<br /> Number of Heads
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<br /> ACKNOtNLEDGEMElJT.-l have reviewed this applicafion and confirm fhe informafion confained herein is frue and correct.Work done pursuanf to this permit must comply with
<br /> cument federal,sfafe,and locallaw The granfing of a permif onty authorizes approved work and no deviations fherefrom.Deviations must frrst be aulhorized In writing from the �
<br /> Building Offrcia!before being authorized under any circumstance.l am the owner,or l am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with fhe Stafe Contracfors Law 18.27 RCW and 296.200A WAC.
<br /> Cify of Everett Official Use On1y
<br /> PERMIT#
<br /> 3.1�. � �t�so 3-va �
<br /> O nerlA ri ed gent Signat re - Date (Revised 10/12/2095) �
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