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<br /> PERM[T APPLICATION j
<br /> BUILDING/MECHAPIICAL/ Pl.UMBING/S[GN/SPRINKLER/DEMOL[T10N i
<br /> CITY OF EVERETT PERMIT SERVICES �
<br /> 320Q CEDAR STREET,EVERETT,WA 98201
<br /> {P}42�-257-8810 � FAK 425-257-8857 �(E)everetteps@everettwa.gov� www.everefiwa.gov/permits
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<br /> PRQ S1TE DI�RESS: PROPER AX�g�� �
<br /> LEGAL,for new consfruction: 5hort Plat/subdivisi n Lot No. {atEach copy of long legal description)
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<br /> OWNER NAME: � � TENANT NAME(ff Commercial): /�/j� � ��
<br /> OWNER MAILING ADDRESS: srRe�r •Q, O�c ��
<br /> C�7y �� STATE � ZIP �7,3 �
<br /> QWNER PHONE: � �� " �„73'y OWNER EMAIL: r� .b r G_-KoP�ir•�W
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<br /> CONTRACTOR NAME: hYei� ' � �
<br /> CONTRACTORADDRESS: sTfteET y�/ S3 SC�
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<br /> CONTRACTOR PHONE: yG�` Q� / CONTRACTOF2 EMAIL: °
<br /> CONTRACTOR LICENSE#(REQUIRED): ��- � C17Y OF EVERETT BUStI1ESS L.IGENSE#(REQUI D): 3
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<br /> PRIMARY CONTACT: ❑OWNER NTRACTOR ❑OTHER(Please Specify) �
<br /> CONTACT AME: CONTACT PHONE: �� �—� f #
<br /> �����GR� CONTACT EMAIL: !� r '
<br /> - '_ ����� i�:���� >..:: `��:_,..»�,�`BUILDING;:P�RI}I117,�AP�'LICATION.;;�w,. � `..4.. '' � ..��-...� �.��_
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<br /> Existing Use of Buiiding: Contract Price of Work:$ Q.`�oo
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑ElecEric ❑Other
<br /> Building Type: ❑SFR-Defached ❑SFR-Attached ❑Duplex ❑Muiti-Family�#of Units: ❑Commercial ❑Industrial �
<br /> Ty e of ProjecY. ❑New �Addifion �R2modei ❑Repair .I. OSign rinkler ❑Demolitian ❑Change of Use ,
<br /> DESCRIPTION OF WORK: �
<br /> ���,���j� �� �.� ��''ids.�� /�✓ �'�v LG�S� �c'�/J�-s
<br /> ASSOC}ATED BUILDfNG PERMIT#(if applicable): �`� "
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<br /> _w�,� MECHAN1CALpERN1�T,;APPLICATION�> _„�;.; `' _ ,�.�. ... ;.;�PLUMBING,PERMIT APPLIG,ATION�_x;«� ��„�
<br /> Type of Project: New_ Addo .Alterafion J_,Repair Type of Project: _New Addn` Aiteration _,Repair �
<br /> #°f Lisf of Fixtures ��f List of Fixfures �°f Lisf of Fixtures #of List of Fixtures �
<br /> Fixtures Fixtures F3xtures Fixtures
<br /> A!C—Air Handling Units Heat Pump Toilet Backflow Prevenfer{Inside 8(dg) �
<br /> Forced Air Systems Unit Heater Bathtub Urinal �
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heafer Refrigerafion Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&pisposal 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/Mop/etc.) O#her: �
<br /> ���';�S�RI�IKL:ER;/SUPPRESS10N4SYSTEM ` �
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<br /> Number of Heads �
<br /> ACKNOWLEDGEMENT.•!have reviewed this appiication and confirm the information confained herein is true and correct Work done pursuanE fo fhis permif must comply wifh �
<br /> current federal,stafe,and locai 1aw.The granting of a permit onty authorizes approved work and no deviations fherefrom.Deviafions musf firsf be authorized in wrifing f�om the
<br /> Building O�cial before being authorized under any circumstance.l am the owner,or l am aufhorized by ihe owner of this properiy to perform the�,vork for which application is made,
<br /> and I comply wifh the Sfate Contracfors Law 18.27 RCW and 296.200A WAC
<br /> City of Everett Officiai Use Only
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<br /> w erlA horized Agent Signature Date (Revise 90/92/2095) � �
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