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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITtON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)ever&iteps�svarekfwa,gav� vwvw.everettwa.gc�vlpermits <br /> (Btue or Black!nk Onty Please) PROJECT�ITE 1N�+CfRMATlON <br /> PROJECT SITE ADDRESS: I:7� ��V'py1Q �I'iv� PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubd(vlslon Lnt No. (attach copy of long legal descriptlon) <br /> CQNTACT INFGRMATION <br /> OWNER NAME; ��,�,(,� TENANT NAME(IF Commeroia!}: <br /> OWNER MAILING ADDRESS: srr�G�r� � � Q <br /> CITV �k',�.Q r� STATE � ZIP � � �L/' <br /> OWNER PHONE: '� � � OWNER EMAIL: <br /> GONTRACTOR NAME: y��, <br /> COIJTRACTOR ADDRESS: sTaEeT �� �j�„�,,{„� <br /> C�TY tr(,/L��,,,. STATE "�'- ZIP � <br /> CC3NTRACTOR PHONE: �q, Q � CONTRACTOR EMAIL• (f'� r�[} <br /> C4NTRRCTOR 61GE1�$�#{REt2UiREDj. ''�C. GtTY OF EVERETT BUS1NE35 LICENSE#(REQtJtREO); _ ��jpr'�� <br /> PRIMARY CONTACT: ❑OWNER CONTRA�TOR ❑OTHER(Please Specifyj <br /> CONTACT NAME: t CONTACT PHONE: Z.�.�� 25� �� <br /> y��' CONTACT EMAIL: � �j ,� <br /> BUILDING P�RMIT 1�pPL:tCAT10N <br /> Existin Use of Buildin : Contract Price of Work:S <br /> Proppseti Use of Buildit� ; Heat Source: ❑Gas ❑Electric ❑Other <br /> Bui[din T �: SFR-Detached ❑5FR-Attached ❑bupl�x ❑fVtulk(-fiarrti{ -#ofUn#ts: ❑Commercial ❑Industrial <br /> Ty e of i'roject`. ❑New DAddition ❑Remodel ❑Re air ❑T.L CISi n �S rinkler ❑Demolition ❑Chan e of Use <br /> �������T�oN o�,����:R �c.� �o <br /> � �`x� <br /> U- <br /> ASSOCIRTECt BUILDING PERMIT#(if a �licable : <br /> MECHpNICAL PERMIT APPLICATION PLUMBINti PERMIT APPLICATION <br /> 7ype of Project: _New _ Addn Alteratlon Repalr Type of ProJect: New Addn Alteratian Repair <br /> #of <br /> USt of F(XUlres. #of Llst o!F-lxtursu #o/ ,Lttt u/FlacEwea #of _...... Eist of Firiures <br /> w�xtures Fiiifurss �Ixfuras Fixfures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory{Wash Basin Drinking Fountain <br /> Water Heater Refri aration 'Shower Floor Drain <br /> Gas Fireplace Wood Stove tCit��ien 5ink&Disposal Grease Trap <br /> Gas Range C7uctin Dishwasher Roof Drains <br /> Clothes D er Hookups Other; Clothes Washer Medical Gas <br /> Ran e Hood Water Heater Other: <br /> Exha�st Fan S�rrk ServiceJBarltv{o /etc. Ofher. <br /> SPRIMKL�R I SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEOGEMENT:I have reviewed this appllcatlon and confirm the lnformatlon confaJned herein is true and correcf.Work done pursuant fo fhis Permif must comply wrth <br /> current(ederal,stafe,and local law.The granling of a permif only aulhorizes approved work and no deviatlons lheref�om,Deviations must Ars�6e aulhorized in wrifing/rom the <br /> Building O�cial be%re being authorized under any crrcumsfance.I am the owner,or 1 am authorfzed by fhe owner of fhis property to periomi the work 1or whrch applica(!on is made, <br /> and!comply wifh fhe State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cify of Everett Official Use pniy <br /> PERMI7#� �� �� � <br /> �. �a •ri .r <br /> Ow �rfRuthor#zed Age Sfgnafuttia Date jRavtsad 9/23I2171tS) <br />