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i <br /> PERMIT APPLICATIOI� <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ 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 /> Blue or Black_�nk_Oni Please, �PROJEGT:SITE INFORMATIQN� ��� <br /> � ��, , - <br /> � ; <br /> � <br /> » <br /> � „ . � E <br /> . � �. F <br /> ,� . � Y�_r ) , s � �, . � �� ... . �. <br /> PROJECT SITE ADDRESS: �,,� SGJ �tKc�C T/ A/1!-I-LL Cv.4-y PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ;�` <br /> OWNER NAME: TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTReeT <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME; ���}� f�Lr.((�Yt�ji �t/-{�Ig"�iW � 11'�'c- <br /> CONTRACTOR ADDRESS: sTReer �I Z j r�c,Kcl v��� D 2 �J <br /> CITY �/�f/�/�/�S/� ���1/(,l�i STATE (�L/{� ZIP JC �� (� <br /> CONTRACTOR PHONE: 2`�'c— 7.3 _���� CONTRACTOR EMAIL: �7���G€��L�ST/�LGt(iylL3rs�G`�• CG�y► <br /> CONTRACTOR LICENSE#(12EQUIRED): 5���--��-�97��J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> _ __. _w..n .,,.._. _ _�_. __, __.w.._� ._ , <br /> _ _ _ _.. . . __ --._ ___ _.. __..� �__. _.___ <br /> PRIMARY CONTACT: ❑OWNER �ONTRACTOR ❑OTHER(Please Specify) �v J-`��J"��`�� <br /> CONTACT NAME: CONTACT PHONE: �5--�._t f6�-Ctlp�� <br /> �-�� /�,r3-2-�i n e3 f,�-,��L �?'Gl ST f�L u vr�r r�3���',Go v� <br /> CONTACT EMAIL; <br /> _ BUfLD1,NG;PERMIT APPLICA�CQN �"_;, <br /> Existin Use of Building: Contract Price of W k:$ ��v[7mt� <br /> Proposed Use of Building: Heat Source: ❑Ga Other <br /> Buildin T pe: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family�#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use • <br /> DESCRIPTION OF WORK: <br /> %ZOGc.yGi �� �'"G�- �5�'rt��S Y'- 2- {-�-GleQ-bae� 3. <br /> ASSOCIATED BUILDING PERMIT# if a licable : <br /> MECHANICAL PERMIT APPLICATION `__ '� ' ' 'PLUMBING PERMIT APPLICATION ,', <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fi�ctures #of List of Fixtures #°f List of Fi�ctures #of List of Fixtures <br /> Fixtures Fixtures Fixfures Fixtures <br /> A/C-Air Handling Units Heat Pump Z, Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler 2„ 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 I Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Mop/etc.) Other: <br /> SPRINKLER/.;SUPPRESSION SYSTEM�`` ' <br /> Number of Heads <br /> ACKNOWLEDGEMENT.�I have reviewed this application and confirm the information contained herein is true 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 the <br /> Building Offi al before being auth ized under any circumstance.I am the owner,or I am authorized by the owner of this property to pertorm the work for which application is made, <br /> and 1 comply ith the State Contr or aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � � /� PER 1 �O 1 �" � <br /> ` <br /> Owner/Au orized Agent Sig at e ate (Revised 0/2016) <br /> �� -� gc�� �- � o�� <br />