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Oct 05 16 11:15a p.2 <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL / PLUMBING /SIGN f SPRIN�CLER I DEMOLETION <br /> CIIY O�EVERETT PERM�T SERVtCES <br /> 3200 CE�AR STREET,EVERETf,WA 9820'1 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everetiwa.gov� wvuw.evereitwa.govlpermits <br /> (Bl�e or Black !nk Only Please? PR4JEGT SITE lNFOlZMATION <br /> PROJECT 5{TE ADDRESS: � � D �Y� r��%� PROPERTY TA7i#: <br /> LEGAL for new construc5on_ Short P1aVsubdivision Lo!No. (ariach copy of long leyal description} <br /> CONTACT INFORMATION <br /> OWNER IJANlE:` `�{J �- (,Z�'��'l�� � ��}-�'� TENANT 1JAME(If Commercia!): <br /> OWNER MAlLING ADDRESS: srReeT � �� --} �U� <br /> Gff'r /�U'��j{l�C l!' S'TAiE ��A Zq' � � �V ( <br /> �WNER PHONE: ��C.Y' — � � ���� � OWNER EMA1L; <br /> CONTRACTORlVAME <br /> CONTRACTOR ADDRESS: sTueeT <br /> em srwre ziP <br /> CON7l2ACTOR PHONIE_ CON7f2ACTOR EMAIL: <br /> CON'tRACTOR LIGENSE�{(REQUIRED): j'�1C YG�S! W���� •� C17Y OF EVERETT BUStNESS LICENSE t�(REQUIRED]:1���.-��-� <br /> PRIMARY CONTAC7: ❑OWNER I�ON7RACTOR ❑O'T'k-1�R(Please Specify) <br /> C�NTACT NAME: CONTACT PHaNE: ���- � � �j— L.�C1��G� <br /> �1 �l.S U }� L � �'J��� �'` CONTACT EMA{L: 4�� rC-�s���-Y, hC� C� '� ���C <br /> 8UILQlNG PERMIT APPL1CATiON <br /> Existing Use of 8uilding: Contract Price of Work:y `�� ��� <br /> Prop�sed Use of Building: Heat 5ource: (�as �EEectric ❑�Iher <br /> Building 3ype: ❑SFR-�etached �FR-Attached ❑Du lex ❑Multi-Famil -#af Units: ❑Commerciai Dlndustriai <br /> Type ot Project: ❑New ❑Addition �Remodel ,�epair �T_I. ❑Si n ❑Sprinkler �Demolition �Change of{Jse <br /> DE5CRIPl70N OF WOR�C: '� Y-� I CLG�.J�l'�-�!� <br /> (,; K� ��� J�c-;-� d fy-�a� -e p <br /> ASSOCIATED BUILDiHG P�RMIT#(if a plicable : <br /> MECHANICAL PERMIT APPLiCAT10N PLUMBING PERMLT APPLICATION <br /> Type of Praject: New Addn Alteration Repair Type of Project: New Addn Alteration Repa�r <br /> FiG�t[ures List of Fixtu�es �r�� Lfst of Flxtu�es #of �ut of Fixtu�es ���f Lfs!of Fixtums <br /> Fixtrxes Fixtures <br /> A/C—Ai�Handling Units Heat Plimp Toilet 8ackflow Preventer Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Cas Piping Boiler Lavatory(Wash Basin) Drinking�ountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Firepface Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Duciin E7ishwasher Roof Drairts <br /> Clothes Dryer Hookups Other: C(othes Washer Medical Gas <br /> Ran e Hood WaCer Heaier �ther <br /> Exhaust Fan Sink(ServicefBar/Mop/etc.) Other: <br /> SPRINKLER!SUPPRESSIQN SYSTEM <br /> tVumber of Heads <br /> ACKNQ4YtEDGEMENT.•!have raviewed ihis appfication and conFiqn the in(om�ation contairted her�in is trve and corre�.�f.YVo�k dono pursuant to this permif must comply w;th <br /> cu�re�t federal,state,and focal/aw. The granting of a pemii!only ar.thorizes approved work and no doviatans fherehom.Oeviations must frrst be authonzed rn writing from the <br /> Hui7ding O�cial baforA being authorizad�nds�any circumstanca.!am the ownei a�I am authnrizBd by Iha ownar oF this propeAy!o psrform the work for which applicatian is mada, <br /> and I comply with the Sfaie Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett O�cia!Use Only <br /> �G _ �(�-5 NC� P # � _ � <br /> �� �� c � <br /> OwnerlAuthorized eM SignaturB Date (Revised 3/23/2076) <br />