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PERMIT APPLiCATIO � I <br /> BtdILDINu r MECHANICAL i PLUMB[NG/SIGN 1 g�RlNKLER f DEMOLITION , <br /> CI�'Y OF EVERETT RERMlT SERVIGES , <br /> 32Q0 CEDAR STREET,EVEREI-f,WA 98201 <br /> (P)425-257-8810 � FAX 42�-257-8857 �(E}everetteps@everettwa.gov� wwva.everettwa.govipermits <br /> {Blue or Black Ink Only Plsase) PROJEGT SITE IN�Oitfi�ATION <br /> PROJECT StTE ADDRESS: �� �.-`�. �'r��'�, f PROPERTY TAX#: <br /> LEGAL€or new construcfron: Shott Plat/subdivision Lot No. {attach wpy of fong legai descrtption) <br /> . _ . . . . ��� ��� v��'����M/ycT�N . . ... . . <br /> OWNER NAME:,, '� �� �.,� ' ��,.�� ����`� TENANT NAAAE(!f Commercial): <br /> OWNER MAILIWG ADDRESS: sTaEEr § �� '�,�. �� <br /> R { <br /> Cf1Y ����.�,,�� < STATE ��� ZIP � � <br /> OWNER PHONE: - �` "T"� �� � � OWNER EMAIL: <br /> CONTRACTOR NAME: �`� '�♦ ` 1�d�]`� '��., G -�- <br /> CONTRACTOR ADDRESS: s�teer �--�"� t �� �� '"`�-''�-`�.._� � <br /> C11Y � �� � �___... STATE ��. ZIP t��eJ" l(,�' <br /> CONTRACTOtt PHONE: -��= '?,.a���7/ CONTRACTQR EMAII: ���1}`�l '�.� � Z�[.G � � <br /> CONTkACT4R LICENSE#(REQUtRED): '�����.�L��G�t��"'��1+ CtTY O�EVERE7T BUSINESS LfCENSE#(REQUIRED):� ��� � <br /> PRfMARY CQNTACT: �OWNER NTRACTOR ❑OTHER(Please Specify) <br /> �ONT�I�T Nl�1ME: �CONTACT PN(�N�: � ,�9 `' �.� ' '� � <br /> ��.,���"�..�,...._ �CC3NTACT EM�IL: ,s'���?'��� � '` C. � '.� <br /> BUlLQIl+�6 PERMIT APPLIGATltiN <br /> Ewstin Use of Buiidin : Contract Price af Wark:$ �: t...%� <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buiiding Type: �SfR-Detached R-Attached ❑Dupiex ❑Multi-Family�of Units: ❑Commercial ❑Industrial <br /> Type of Pro'ect: ❑New ClAddition ❑Remodel epair CiT.L CISi n C7Sprinkler �Demotition OChange of Use <br /> o�sced�raa�o�woRK: ��-�-��- �-�-�``-- ��`�...��, c�J �>. � �'� Gt-,C..k�_ c,-.,��� (� L2�.���'�. <br /> ASSOCIATED BUILDING PERMiT#(if ap licable : <br /> MECHANICAL PERMtIT APPLICATlON RLUMBIN6 PERMIT'APPLICATtON <br /> Type of Project: ,New Addn _A4teration Repair Type of Project: New ,Addn _Alteration Repair <br /> #of tist of Fiartures #�� List of Fixtures �°g LAst af Fixtures #°f List of F�ctures <br /> Fdxtures Flxiures Fixtures Ffxtures <br /> A/C—Air Handling Units Heat Pump Taiiet Backflow Preventer(Inside Bld ) <br /> Forced Air Systems Unit Heater Bathtub Urinai <br /> Gas Piping Boiler Lavatory(tNash Basin) C}rinkin Fountain <br /> Water Heater Refrigerati�n Shawer �'toor Drain <br /> Uas Fireplace Wood Stove Kitchen Sink&Oisposal Grease Trap <br /> Gas Ran e Ductin Dishwashsr Roo#prains <br /> Ciothes D er Nooku s Other: Clothes Washer Medica4 Gas <br /> Range Hood Water Heafer O#her. <br /> Exhaust Fan Sink(Sen+icelBar/Mop/etc. Other: <br /> SPRINKI.E�t 0 SUPPRES$l�BN SY$TEM <br /> Chemical or Watsr No.of Heads <br /> ACKNOWLEDGEMENT.-i have reviewed this application and confirm fhe infarmation contained herein is true and correct. Work done pursuant to thfs permit must comply w'tth <br /> cunent federal,state,and locai law.The grariting of a parrrrit only authoNzes approved work and no devietions therefrom.Deviations must first be avthorized in writing from fhe <br /> 8uftding Officiaf before being authorized urtder any circumstance.I em ihe owrrer,or f am authorized by the owner of this property to perform fhe work far which appiicatfon rs made, <br /> arrd t comply with fhe Stafe Contractors Law 98.27 RCW and 296.200A WAC. <br /> � �J � City of Everett�cia!Use Only <br /> � a �j � ,. � PER T <br /> �.... <br /> � � "��� � ��O - �O <br /> OwnerlAutho�ized Age�t Signature Dete (Revised 9/23/2Q78) <br />