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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CE�AR STREET,EVERETT,WA 98201 <br /> (P}425-257-8610 � FAX 425-257-8657 �(E)everetteps@everettwa,��u� www.everettwa.gov/permits <br /> (Blwe or Black Ink On1y Pleasej PROJECT StTE i!�#�ORMATION <br /> PRQJECT SITE ADDRESS: ,,��j(;} L(,�,�/`(�n �(V" pROpER"f"Y TAX#: <br /> L.EC'.sRL for new construction: Short�taUsu6e�ivisl�n L4t No.� (attach copy of long legal descriptlon) <br /> �QN7A�GT It�i�QRMATIt�N <br /> f)UYf�tER NAME; �P�`�L(� �,� TENANT NAME�If Commerciai): <br /> �WNER MAILING ADDRESS: srReeT 2(oQ(p 1( y� (��, Y' <br /> CfTY STATE �p ZIP 1 O!�!3 <br /> OWNEi2 PHONE: `{+�; ,''�()(p �C�O '2,�3'gZ- OWNER EMAIL: <br /> CONTRACTOR NAME: � n C <br /> CONTRACTORADDRESS: sTReeT �L� ��,� <br /> CITY STATE �-� Z�P + <br /> CONTRACTOR PHONE; �q, Q CONTRAGTOR�MA1L� <br /> __. <br /> GC3N7`��2tAGTqR L10ENs€#{REauIRED�: -� cirr�F�v�R�'T'r$UsrNEss LIGENse#(REQ ED}: Q�p'�� <br /> PRIMARY CONTACT: ❑pWNER CONTRACTOR ❑OTHER(Pleasa Specify) ' <br /> Ct?N'fACT NAM��� CONTACT PHONE: j,�."�L� 25� (�� <br /> GONTACT EMAIL: � �� �� <br /> t�UiC.bING PEHLMIT�►�'1'1.I�I�[TIC1N _ <br /> Exrstin Use of Buifclin : Contract Price of Work:� �C►b•�� <br /> Prop�sed Use of Buildla : Heat Source: a& ❑Electric ❑Other <br /> Builc�in Type: fiR-t3�tached ❑5FR-Attached ❑Du lex ❑tvlulti-�amii -#of Units: ❑Commercial ❑Industrlal <br /> Type of Prajc�ct: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Sign �5 rinkisr ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF W�RK: Q���� �as .�r�� <br /> i1, <br /> ASSQCIATED BUIL.DING PERMIT#(ii a plleaF�lo ; <br /> MECHANlCAL PERM�T APRL[CATItiN pLUMBIN+C PERMlT APPLI�ATION <br /> Type of Project: _New _ Addn _Alteration Repair Type of ProJect: New _Addn _Alteretion Repair <br /> #of _:�Ist uf flXtures #o/ � #of #of <br /> fixtores Ffxtui�9s� �fsto!-�lxturas � -LJ6t-ot-F#xturss _.._.,.. _........_�{xtoFf,txturea __ <br /> �ixtures Flxtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Prevr�nier{Inside B{d ) <br /> Forced Air Systems Unit He�tsr BaRhiub Urin�1 <br /> Gas Piping �o11er Lau�ta {Wasti 8asin [lrinking Fountain <br /> Water Heater Refri er�#ion Shower Floor Drain <br /> Gas Fireplace Wood Stave Kitchen Sink&Dis osal C �:;:<>r� T,,.� <br /> Gas Range Gitc;ing dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: 'Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other. <br /> Exha�st Fan Sink ServicelBar/Mopietc, Other: <br /> SPRtNKL�R/SUPPEtE$SiQN SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNpWLEDGEMENT:l have reviewed this applicatlon and confirm fhe inlormation confained herein!s fiue end correct.Work done pursuant lo fhis permit must comply with <br /> currert!tedera�,state,and Ir�ce!lsw, rhe gr���tin�of a permtt only au�hodzes approved work and no deviafrons fherefrom.Deviallons must Brsf be aufhorized in writing irom 1he <br /> BurJdin�g C711Iota14efnre being authnnzad ue�derany circurr2slsnce.I am the owner,or I am aulhorized by the owner of this property to perform the work for which applicatlon is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> �ily of Everett Oflicial Use pn{y <br /> � IZ'S'�� PER T � ( ` � <br /> Qw erlAuthar(xed Age Signature Dale (Revis�d 9l23/1F7Gj \ <br />