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PERMIT APPLICATIO <br /> BUILDING ECHANICAL/ PLUMBING /SIGN INKLER/ 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@everettwa.gov( www.everettwa.gov/permits <br /> (Blu�or.;Blacki�nk 4nty Piease� PRtiJECT SITE 1�1FQ.F�MAT�aN: <br /> PROJECT SITE ADDRESS: �rp 2( t.Ve re en Wa PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> 'CONTACT INF�fRMAT10N' <br /> OWNER NAME: CO�—U M,l31A �SG��� �� TENANT NAME(If Commercial): P�a,nG j e�$ <br /> OWNER MAILING ADDRESS: s�eer Ol�� I�D E P����T �—`�_��i I I�' <br /> � CITY :�J�`Y�--�lv N��� • STATE T L . ZIP �'3Z!(.JZ <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME, V Y11 V 2.1'�S I M�c�tan iccLl GO►'1 �'1 G. <br /> CONTRACTOR ADDRESS: s�eEr I�(p� � � P L W <br /> CITY ��+\�I���{,/ � STATE yVA Z�P "�27+' <br /> CONTRACTOR PHONE: ZO(o • 3�oA-' �J91 O CONTRACTOR EMAIL: M"� h. � . �,Q(h <br /> CONTRACTOR tICENSE#(REQUIRED): U N I V M G���N:1 CITY OF EVEREIT BUSINESS LICENSE#(REQUIRED):O`U�Q�4� <br /> _ <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2O(p » "J� ^ (p1 a(� <br /> �yGW\ L'/N1�'1 CONTACT EMAIL: Y�I Yl�'1 @ lil.l'Y1G1 . CO PY1 <br /> , : <br /> � <br /> , ' BtJ.1�DtNG hE�M�T APPLtC!A�7�ON':', : <br /> Exi _ <br /> sting Use of Building: H e0.I'N� Gt�Io Contract Price of Work:$ r�� <br /> Proposed Use of Building: Ne�ll-� CI l�-IJ Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: �Commerciai ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair �T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ��„r���5 ,,,� �t S� N�'�,�, �'U1,S,�,M Q./1� U'�,� <br /> �u�o �1c.w Ce,�`i ut.9 -{�u.rLs. � <br /> ASSOCIATED BUILDING PERMIT# if a licable): <br /> MEGHANICAL'PERMIT APPLICATIO�I: PI�U;MBING PERMIT APPLtGAT�QN" <br /> Type of Project: New Addn _Alteration Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fi�ctures #of List of Fiutures <br /> Fixtures Fi�ctures Fintures Fiutures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems 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 2 Geilin S Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> 9PRINKLER I SUPPRESSION SYSTEM, <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is frue and correct. Work 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.Deviations must first be authorized in writing from fhe <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made,, <br /> and 1 comply ith the State Contracfors Law?8.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> �IZ 1 �C�Z� - D �� <br /> � <br /> Owner/Authorized Agent ignatu Date (Revised 9/23/2016) { <br /> �C _z � <br />