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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/PLUMBING 1 SiGN /SPRINKLER ! DEMOLITfON <br /> CITY OF EVERETT PERM�T SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8B57 �(E)�vsreite�ps�ev�rsitVv�.:g�rv j ww+N.everettwa.govlpermits <br /> (Blue or Black lr�k �dniy Plesse) PROJ6GT StT'E 11�F"�liiMA7t�l� <br /> PROJECT SiTE ADDRESS: � �'� PROPERTY TAX#: <br /> L€GA(„for new conslruction: Short PlaUsubdivlslon __ Lot No._ (attach copy of long legal descripfion) <br /> C�lNTACt iNl»�1RlVIATI+tiN <br /> C7WN�R NAME: (�,1(��,,""�` �� TENANT NAME(if Commerciat): <br /> OWtJER MAILING ADDRESS: sTREer � y�y^�,G <br /> "���� �'�"�/� STATE �"^" 71P � <br /> OWNEft PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: l-��,�"'��� <br /> CONTRACTOR ADDRESS: sr�eer ��� <br /> Cf1Y STA�ic /'t� ZIP ��t,1 f <br /> CONTRACTOR PHONE; 'r'� Q CONTRACTOR EMAIL: (�(���? i G`,{�'y''�F'1�'(x,'�'j�'l.� . (�� <br /> G(7P�I'fFiAGTOf2 LICENSE#(�?E�tJIf�E[]j; �`}��,�,' �'y�,�l��Z(,�� CITY OF EVERETT BUSINESS LICENSE#{REQlIIREp); ��,pt.�'�-j� <br /> PRIMARY CONTACT: ❑OWNER �CONTRACTOR ❑dTHER(Please 5pecify) <br /> CONTACT NAME: • CONTAGT PHONE: � ��� �� <br /> ��.�.� CONTACT EMAIL; �� 4,� ('����f� .�M <br /> l�U1Lt�lNf3 P��ttf�M1"A���;tC�TIG�� <br /> �xlstic� Use of BuildYn�; �onRraCf Prlce of Work:S �� �y <br /> Pre�po�ec�Use of Builtlin � Heat 5ource: ❑Gas lectric ❑Other <br /> $uildin Tp�e: SFR-Detached �SFR-Attached ❑pu�lex ❑Muiti-Famif -#of Unfts: ❑Commercial ❑Industrial <br /> Typo of F'raj��,t� ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. C1Si r� ❑Sprinkf$r ❑Demolition ❑Uhang�of Use <br /> DESCRIPTION OF WORK: <br /> �n 5�"� ��--�u� �- �i n c�w� �' <br /> ASSOGIA'TED BUILDING PERMIT#{if e3F>�licable : <br /> MEGHANICAL PERMIT APPLIC�ITtQN PLUINBINti PERM[7 APPLlCATION <br /> Type af Project: _New Addn _Alteration Repalr Type of ProJect: New _Addn _Alteretlon _Repair <br /> #of #of <br /> Fixfures List of Flxtures Llst of F/xfuraa #�� Llst ol Flxtures #of Llst o/Flxtures <br /> Fixtures Flxtures F►xtures <br /> A/C—Air Handlin Units ' Heat Pump Toifet Backflow Preventer(Inside Bld ) <br /> Forced Air Systems Unft Heater Bathtub Urinal <br /> Gas Piping Boiler (�avato Wash Basini Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Firep(ace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ducting Dishwasher Roof Drains <br /> Clothes Dr er Hookuns Other. Clothes Washer Medical Gas <br /> Ran e Hood Watar Heater Qther: <br /> �xhaust Fan Sink Servlce/Bar/Mo /etc. Other. <br /> �PR1Ni{LER!BUPPRESSION $YST�M <br /> Chemical or Water No, of Heads <br /> ACKNOWLEDGEMElJT:I have reviewed thls applfca�ion and confirm fhe lnforma8on contatned herein rs trve and correct. Wark done pursuaN to thts peimlt musi comply wi�h <br /> curren[lederal,state,and local faw. The granting of a permit on7y authorizes approved work and no devla(lons fherefrom.Devlailons musl flrsi be authorized in wriiing 7rom the <br /> Buifding Olfrcra!before being auihorized under any circumslance.I am�he ownei,o�I am aufho�ized by Ihe owner of thls property!o perform the work for whlch eppliceflon is made, <br /> and!comply wilh the Sfate Conlractors Law}8.27 RCW and 296.200A WAC. <br /> CNv oi Everett O�cfe/Use�nh <br /> � PERMIT# <br /> � <br /> ��� � p .l-� � � _� �, _ ,�;, <br /> ��� , , <br /> _ ,,,,,,,.,, : <br /> 'Owne IAuthorizeu Agan ignature Date �� �Revtsed 9/23% D76j <br />