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PERM(T APPLICAT[ON <br /> BUILDlNG � MECHANICAL f PL.UMBING ! SIGN i SPRINKLER 1 DEMOLITIdN <br /> CfTY O�EVERETT P�RMIT S�RVlC�S <br /> 3i�4 CED;��ST�=ET, EVERET T,VL'A 9820� <br /> i�;�2� ��'-&81C ; �_=tX���-257-8857 j([)everetteps@evereiFvra. ov w�wr.everettwa.povlpermits <br /> (Blue nr Black Ink Qnly Please} PROJECT SlTE INFQRMA7I�N <br /> PROJECTS17C,4DDR�SS: ' f �`jF.�� ��� �.Zl�(� �1 FIiU�'tKfYTAX3f: �,�73�� �`j(�I <br /> �EGAL for new cons;ructicn: Shc^Pa_s�hc:v';io� c:Nc, (aitacn ccpy of long!egal descript�on) <br /> CONTACT INFORMATION <br /> OWNER NAME: � <br /> � � �I'�� ����J TEhIANT NAME�If Commerciai): <br /> OWNER MAII.ING ADDRE5S: sT=:=�r ! � i""(.l.-Yl lW►'��'_---t� .`_ _� <br /> - - �= w� Z'P 1 � � <br /> OWN�R PHONE: OW1�ER ErA4ll.: <br /> COfJTRACTOR NAME: {��;If�I-(�f��G`I 1 GN L. ��-E jL �C��T�"/� <br /> CON�RAC70RADDRESS: sr.-.=�; � , r , � ( � �UX ���' <br /> � � �J v�� 57A7= �rT Z�P <br /> CON'TRACTOR PHONE: "t Z���j�`j- f " CON7"R,4CTOR EMAIL; ' r �- y C l�" rY'�j���.A C��f�f <br /> CQNTRACTdR LiCENSc=;t��..=�=� : �(,+f�-�f����� CITY OF EVERETT Bl.�5fNE5S LICENSE#(REpUIRED): ��� <br /> PRIMARY CON'A�'t': p C'�iti�R ��QN7R.�CTOR ❑ O i HER fPlease S�eciiy) <br /> CONTACT(V.4�JIE• CONTAC7 P4DNE: 2���% 3-C7f�'7� <br /> V�I J�'��I(� �� GONTAG? EMAIL: L<•/1�iE.'H'}'I��'�._L LY�(lY /L�.C,G�'�Y� <br /> UlLDtNG PERMIT QPALIGATION <br /> Existi�� U�e o�B�i;�'r.�- Contract Arice of Work: $ <br /> Proocsed Use�=3 '�'ro_ Heat Source: ❑Gas ctric ❑Other <br /> Bui!di�a Tvp�: , R-Detacnz� ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Uniis: ❑Commercial ❑Industrial .-� <br /> Ty�:e o`Pr�;e;.�: �'N�1. �L�1:,odi?icn ❑Rerrtodel ❑ReFair ❑T.I. ❑Sign ❑Sorinkler �Demalitior �Change of Use <br /> DESCRIPTION OF WORK: <br /> �t�Y�i.�. � ��� � GUG�=�.� �.���� <br /> ASSOCIATED BUlLDING PERMlT=�;i opGlicab(e}: <br /> MECHANIGAL PERMIT APPLICA710N PLUMBING PERMtT APPlICATION <br /> Type oF Project `New Addrs _Alte-ation _Repair Type of Projecl: _New Addn Alteratian „Repair <br /> #of <br /> Lrst of Fixiures Fiztu Es �-�st of Fixtures �°f List of Fixiuras #°t List of Frxlures <br /> Fi�ures ' Fixtures <br /> Fixtures <br /> A/C-Air Hznclinc U�,:s �.;Gt�u�r,p i cilet Back°low Preven;er(Inside Bldg? <br /> ForcedAir Systems U�i;Neaier Bathtub Urinal <br /> Gas Pip�ng 6oifer Lavatory(Wash Bas'n) Drinking Fountai.� <br /> Water Heater Rafriaera6cn SFower Floor Drain <br /> Gas Firepiace Wood S�ove Kiicnen Sink&Disposal Grease Tra <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hc�kups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other. � <br /> Exhaust Fan Sink (Servir,e/Bar/1�1op/etc.) Other: <br /> S�RINbCLER/SUPPRES510N 5YSTEM <br /> Number of Heads <br /> ACKNO WLEDG�M6V7!have ieciewed lhrs app/fcation and confirm fhe in(ormation conta�ne�herein rs Uue and co�recl. Work done purso�ant to fhu pe�mit must comply with <br /> cur�ent federal, sfate,and locai law r`he g�anlmg of a permit only authaizes dpproveo'wo�k ard no deviations ibe2,Yom.Deviatrons musr frrst be aufhorized rn w.�iting from fhe <br /> Building ONc"aJ he(nre be�ng avtho,Yred under any crrcumslance.!am lhe�wrer,�r 1 am author.zed by f«e ow��er oi fnls property to pe,7orr:i the work for whicY,applicatron is made, <br /> 2nd 1 cmnpty with the State Contractors L'aw 18.27 W and 296.200A WRG, <br /> � City nf�verett Oflicial tlse Only <br /> � , r 7"�Z�(� PE��n�T„# l�� V� � <br /> 1� � ` <br /> Ow rlAuthorizzd AgentSignafure Da,e (Rev�s2d�2U/?O16) <br />