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oiri7�2o�s 7� : aa ttsio� P. 002�002 <br /> P�RMI�f APPI.ICATlON <br /> Bl!lLDING / MECHANiCAL/ PL.UMBING /SlGN /SpRINKLER/ DEMOL.ITION <br /> CITY OF EVERE77 PEftMIl�SERVIC�S <br /> 3200 C�DAR STREET,�V��ETT,WA 98201 <br /> (P)425-257-8810 � FAX a25-257-8857 �(�)everetEepsCa evefeitwa,r�av� www.eVerettwa,gov/perYr3its <br /> Blue o��lack �nk OIn[y� Please) PROJ�CT S1TE IN�ORMAT�ON <br /> PROJ�CT SITE APpR�SS: Sr �.O ✓� f'L J� V PROP�R7Y TAX�k: <br /> L�GAL for new cflnstruckio�: Short Pladsubdivlsion Lot No. (�ttach copy of lone legal desc�iption) <br /> CONTACT INFORMA�'ION <br /> QWNER NAME: � �'}V TENANT NANI�(If Commercial)' <br /> OWNER MAILING ADpRESS: �rna�'r <br /> CIiY ' STATE z�P <br /> OWNEFt P}1oNE: OWN�R�IIAAIL: <br /> CoNTRACTOR NANIE: � S�.FS � S^ <br /> CONTRACT�R ADpRESS: sT�e�r <br /> CITY STATE ZIP � <br /> CONTFtAC70R PHON�� Z.S •L�(� I CONTRACTOR EIVIAII.: <br /> CON7RACTOR L.IC�I�IS�#(R�QUfR�p): � f G .Z CITY OF EV�R�7T�115lNESS�ICENS�#�REClUIR�1]):Ql�t� <br /> PR[MARY CONTAC7: ❑OWN�R ❑CONTRACTOR L7 OTH�R(Please Specily) <br /> cONTAcT n1a,t��_ cONTACT PWaN�: �' ��� �Z <br /> �UCI� CONTAC7�MAfL: <br /> BUILEaING P�Rl11�iT APPL.ICATION <br /> Existin Use of�uildin ; �-�- Contract Prlce of Work$ d r – <br /> Proposed L1se of�uilding: Heat Source: GEUas Q�fectrie G70ther — <br /> �uildinq T e: ❑SFR-Detached ❑SFR-Attached ❑Du lex L7Multi��emil -#af Units: _ ❑Commercfal ❑Industrial <br /> Type of Project: l�New ❑Addition C1Remodel �Re air C�T,1, ❑Si n ❑S rinkler ❑Demolition �ChangE of Use <br /> aESCRIPTION OF WORKh �� � L _ �/I��� <br /> 4� �j� V <br /> < « <br /> AS50C1QT�D BUIL.pING P��M1T# it'e licaple): <br /> MECI�ANIGA� P�RMtT AAPLICATION p1.UMBING P�ItMIT APPL.�GATION <br /> rype of ProJocC: New � Aqdn ^Alterailon _Repair �ypa of Pro�ect: �Ngw _Addn ,�,4lteration _12cpair <br /> #of Z;s[of Fixiures ��f Llsz of FixtwAs #of ��s!oP Flxtures #of List of�Ixiures <br /> FixYures Fixfures FJxiures Fixtures <br /> A/C—Air Handlin Units Heat Pump Toilet �ackflow Preventer(lnside Bld <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipin �oiler �avato (Wash Sasin) prinkin Fountain <br /> Wafer Heater Ref�iqeration Shower Floor�r8in <br /> Gas Fireplace Wood Stove Kitchen Sink&I�is osal Grease T�a <br /> Gas Ran 9 DUCHng pishwashef �'o0f Dlains <br /> Clothes� er Hooku s 0!ner: Clothes Wasner Medical Gas <br /> �anqe Hood Water Meater Other; <br /> EXh�ust Fan Sink{Service/BEfIMo �etc, other, <br /> SPRINKLER/SUPPRESStON SYST�M <br /> Chemical or Water Na. of Heads <br /> ACKNOWLEDGEM�NT�!have rav�awea this app�icaf/on and confirm tne intormation contained here/n is lrue and correct.Work aone pursuant to this per,nit must comp/y wdh <br /> Current fadoral,state,and loca/law. Tne granfing of a peimrt on�y�ufnodze�approved work and no devistions lBerefrom.Devlatlons must first be author�red in writinc�/rom fhe <br /> Build;ng Ofllc/al 6efo�o being authorired under any clrcumstanco.1 sm the ownor,or 1 am auihorized ky the owner of this proper�y fo por�orm tAe�vork for wn/ch appffcatlon is made, <br /> anG!comp/y with the State Gont/acto�s Law 18,27 RCW and 296,200A WAC, <br /> City o1�Ve�att ONlCI�I Use Only <br /> P�RM�1T# <br /> � �, , � � ��, , <br /> Own uthorized Apent Slgnature Date (�evised 9/23/2016) <br />