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� PERMIT APPLICATtOf�[ <br /> BUILQING!IVIECHANICAL!PLU�BING!SIGN 1 SPRtNKLER I DEM�LITION <br /> CI7Y QF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREE7,EVERE€T,WA 9$201 <br /> �Py 425-257-8$'i0 � FA?C 42b-2b7-8$57 �(E)everetteps@everettwa.go�� rvww.everettwa.govlpermits <br /> {Blue or Bla�k In[c Only Please� :PROJE47 SITE,INFORMATION . � <br /> PR�JECT SIYE Al7C1R�5S: � y�, = cr�'�"� PROPERTY TAX#:�8'aS/rydQ�O7 t� <br /> LEGAL for new construction: 5hort Plafisubdivtston L�t iVo. (attach copy of long legal description) <br /> - � CONTACT IN�ORMA'1"IdN <br /> OWNER NAME: �} � .� TENANT NAME(If Cammerciai):� �t.v��'7 y�i��� Zg <br /> flWNER MAILING ADDRES3: st��r (,�Z� 2, {, Nb <br /> cnv sra� y�j ziP <br /> OWN�R PHONE: OWN£R EMAIL: <br /> CON7RAGTOR NAME: Q.,u � <br /> COIV�RACTflR A�DRESS: srnser �y�� s� rsy �L� � <br /> CITY �' �yy1 S7ATE ZIp -G� <br /> CONTRACTOR PHONE: y?�j3 �I'y Z�S�Z CONTRACTOR EMAII.: '�� ,e �/ �, �C <br /> CQNTRAC"I"OR LICHNSE#(REQUiREDJ: �►► YY4 L.D�I�1C,T CITY OF EVERETT BUSINES5 UCEN5E�(RE4UIRE : �'?�jI <br /> PRtMARY CONTACT: ❑QWNER �CON'fRACTOR ❑OTHER{Please Specify} <br /> GflHTACT NAME: CQNTQGT PHON�; ��'7� y7 ���� <br /> ��fG�G �GriC•t CONTACT EMAtL: .c �,LM �yra' .CD'ivt <br /> • :.. _. <br /> BUILDING RERMIT APPi:ICATION ° .. .- � <br /> Existing Use of Bu1[ding_ Cantract Price of Wark:$ 2� ?g .t�7 <br /> Proposed Use af Building: Heat Saurce: as le �rie DOther <br /> Building Type: �SFR-Detached ❑SF12-Attached ��uplex OMulti-Family-#of Uniks: ❑Commercial ❑Industriai <br /> T e of Pro'ect: ❑New �Additinn emodel ❑Repair ❑T.�. ❑Sign ❑Sprinkler DOerr�ofition OChan e af Use <br /> bESCRIPTlON aF WORK: f ` ,�_i �J� rt� �K�p r+ <br /> n/'�+�t1 '��,•G�,t�a,r�f xn7�+�+'� �i� d�. �sf�c.t'.G l �• f,�r��w <br /> S ���-( <br /> ASSOCIATED BUIL.DIHG PERMI'i'#(if applicable):��7�a"0 t� <br /> MECHAN1Gp�`p�RMIT AP.PI:ICATiON. . ! � �I,UMBING'�P� 1T APPI.ICATION- <br /> Type of Project: _New _ Addn Alteration _Repair Type of ProJect: _New �4ddn _Alteration _Repair <br /> #of tis!of Fixiures #of List of Fizturos #�f Liet of Fix[uras �#of trst of Fixtures <br /> Fixtwes Fixtures FJxtures xtares <br /> AIC—Air Handling Un�ts Heat Pump Toifet � Backflow Preventer Qnside Bld � <br /> Fosced Air Systems Unit Heater Bathtub � Urinal <br /> Gas Piping Soiler Lavatory(Wash BasinJ I Drin[cing Fountain <br /> Water Heater Refri eration Shower I Floor Dra�n <br /> Gas Fireptace Woad SEove Kitchen Sink&Disposal � Grease�rap <br /> Gas Range �uctin Dishwasher � Rvof Drains <br /> Ctothes Dryer Haokups OFher: Cfoihes Washer I Medical Gas <br /> Ran e Flood Water Heater � Other: <br /> � �xhaust Fan 5ink{5srvtcelBarlMopfetc.) � Other. <br /> � <br /> :.SPRINKI.ER.1 SUPPRESSIt�N'SYSTEM <br /> Chemical or Water No.of Heads � <br /> ACKNO WLEOt?EMENT:1 hav9 re viewed lhis applicaUon and confirm Ihe in/ormefion cantarned herein is f rue arrd comecL 4Vork�/one purserant l0 lhis permit must comply with <br /> cumen!federal,slale,a�d Jacallaw.7he granting ef a permrl only authorizes spprover!work and no deviafions Iherefiom.Oevlsll�Rs mus�Crst ba authorized!n w»Nng(rom Ihe <br /> 9uilding Ofldat belore bei�aathorized under any cJrcumstance,l am the owrrer,or f am authorized by fhe ow�er of thls proAeRY ta pertorm the woric for vihich applicatron is made, <br /> arrd f coa S!a rdL�Ts Caw�'B:Z nB 29S,2UOA WAC, I <br /> / c,ryof��rerea o�rcr�r vse oRry <br /> CPERMIT <br /> � �� /� -- � <br /> OwnerlAuthorized Agent Signature DaSe (Revlsed 9/�3/20t6j <br /> I <br />