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PERMIT APPLICATION <br /> BUILDING / MECHAN(CAL ! PLUMBING / SIGN J SPRINKLER ! DEMO�ITION <br /> GTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT.WA 98241 <br /> (F'}425-25t-881U I FAX 415-257-(3g57 � (�)everetteps@evereitwa.gcw� w�nn,v.evcrettwa govipern=ds <br /> (Bfue or Black fnk C3�e1y please) PROJECT SJTE INFORMATION <br /> PROJECT SITE ADDRESS: '�'�rQ �. � �„► ^�} PROPERTY TAX#: ��,(�yi ,Iq' <br /> ���`ar�.� fUr r7NM+ren;tr�ac;i�,n Star3rt i�lailsi�bctivistcr: . LoF No. iattach cepy of larg;egal desr:r�pi�ii�j <br /> CONTACT INFORMATION <br /> OWNER NAME: �'j,�''� � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: s,�t-� <br /> Cll'Y <br /> . .. >.. ,iE:. <br /> OWNER PHONE: �j(�p– ,C� . ! OWNER EMAIL: (�„�,}-�y�, <br /> CONTRACTOR NAME CD,�f� r,���,1�' ���"f�� �NC <br /> CONTRACTOR ADDRESS: •:.r:�: /7(j,z�/ /S'�h �.y�,�,� �'£ � ��/� <br /> c�,V c�1°_j� LL �J/�- <br /> �� 9d�/� <br /> �ONTRACTOR PHONE, �y+„�,�-���r"�',�"�� �f` CONTRACTOR EMAIL: Yj� �p �"{�Q/� �Q�`j,rc,/N<a,CGYy! <br /> �ONTRACTOR LICENSE#I.RECJU9FtEt,);: �('j�Q/�/,���'p,�,�G'/y� �i7y OF EVERETT BUSINESS LICENSE#;R£QLlIREDj: O3�s�`1�'• <br /> 'RIMARY CONTACT: � OWNER �'EONTRACTOR ❑OTHER(Please Specfty�___ <br /> _ .... ...___ _....._ _.... _____ <br /> :ONTACT NAME: Gt�ldTACT PHONE� {' t���-�.S(�QS—D/// <br /> �AQ� C.D1PN/s�{, oF�iC� rnA�vAGF�2 CONTACT EMAIL� Yi ����T�yy�C���,NC�;�;�j <br /> BUILDING PERMIT APPLICATIt?N <br /> �sci;stir�c�Use of Bu�r�iia�c• �j � �"'jj Contract Price of Work: a, � �� .UO <br /> 'rr>��v��ec+Use of p��il�iirlr: Heat Source: ❑Gas ❑Electric ❑Other <br /> _._. ,. ____..__ <br /> 3u�td+rir� l ype �fR-Deiach�d OSFR-Attached ❑[]upiex ❑MuIU-F�mity-#of Units._ .__ , ❑Commercial ❑Industrial <br /> y�:�cf Praject; ❑New ❑Addition ❑Remodel C�� ❑7.�, ❑Sic�r; ❑;�E;Ar�,°rkt�� ❑Remolition ❑Cl��n �of Use <br /> )ESCRIPTION OF WORK: �E <br /> R.PI'�'iQU� �!»'+-� r�'�u�ArJ a�c�' �'y�Gac� w��k. QOn'cP � . <br /> �SSOCIATED BWLDING PERMIT#�li a tica�le <br /> MECHANICAL PERMiT APPLICATION PLUMBlNG PER�IIT APPLICATfON <br /> ype of Project: New _ Addn _Alteration _Repair Type of Project: `New Addn _Alteration Repafr <br /> #of #of #of <br /> �ixrures Lrst of Fixtures Llst of Fixtures #°� List of Ffxtures Lisf of Fixtures <br /> Fixtuies Fixtures Fixtures <br /> A/C–Air Handlin Units Heat Pump Toilei Backfiow Preventer Qnside Bld ) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavator (Wash Basin) Drinking Fountain <br /> Water Heater Refri eration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink 8 Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Ctothes Dryer Hookups Other Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BarlMo /etc. Other <br /> SPRiNKLER/SUPPRESSION SYSTEN4! <br /> Numk�er cat Neacls <br /> :;KNOWLEDGEMENT !have revrewed this applicapa�and co�>firm the informalroi�confained herein is true ar�d correct Work done pursuant!o Ihis permit must cvmply w�tt, <br /> rrrent federal.sfate.arrdlocal law The y�anting o/a permi�onty authonzes approvsd work and nv deviafrons theretrom Deviations�riust first be authonzed in wnting from the <br /> �ildrng UKcral belore be�ng authorrzed unde�any arcumstance J am tno ownar,or I arn au7h�rized by the owne+nf thrs property[o perfnm�!he work for wh�ch applicatwn is made <br /> id I compty wilh!he S(ale Conlractors Law 1B 27 RCW and'196 ZOOA WAC <br /> C;rty of Everett Officfal Use CJr;ly <br /> PERMIT�t ` I��� <br /> C�-�;,�,,,x /Df�b ! - �� P�� / �`" � 1 <br /> wrrter�a�Yhor'rz�a�!AgeRt Signature Date � tRevt�e�cr 5.u�1�'�(�76) <br />