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PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 � FAX 425-257-8857 �(E)averetteps@everettwa.g�v� www.everettwa.gov/permits <br /> �(�Ic�e ar���Black Ink+t��1y��Plea�e�} �`PRClJ6CT�17'�INR4RMA7'ION � <br /> 'PRt?JECT SITE ADDRESS: � C�D PROPERTY TAX#: <br /> L.EGAL for new construction: Short PlaUsubdiwisian Lof No.� (attach copy of long legal descriptlon) <br /> '"C�NTACT INFORI'YtATION°` <br /> OWNER NAME: TENANT NAME(If Commerciat): <br /> OWNER MAILING ADDRESS: sraeeT � 2, �--�-� ST <br /> 1 �� ��� <br /> Cm �� STATE UJ� ZIP <br /> OWNER PHONE: 2„� 7 � ''��Q OWNER EMAIL: <br /> CL7NTRACTOR NAME: n ty�� <br /> COMTRACTORADDRESS: sTrxeer t� (��,� <br /> CITY STATE �-^ ZIP I <br /> CUNTRACTC3R PHONE: �q, �} {� CONTRACTOR EMAIL• � � ,(",�J <br /> CQN'1`F2AG7UR LICENSE#(REC]UIRED}: � CITY OF EVERETT BUSINESS LICENSE#(REQUIRED}; ���� <br /> P�tMARY CON7ACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> C�FlTACT NAM��� CONTACT PHONE; �.�G�" 25+t� ��G� <br /> CONTACT EMAIL: � �� �� , <br /> BUILDI G`P�RMIT APPLICATION <br /> Existin Use of Buildin : Contract Price of Work: � �.� � <br /> F'ro os��#Use of B�s'din : Heat Source; as ❑Electric ❑Other <br /> Buildin 1' e: FR-Detached ❑SFR-Attached ODu !ex ❑Multl-Famii -#of Units; ❑Commercial ❑Industrial <br /> T a of Project. C�New ❑Addition ❑Remodel ❑Ra air ❑T.I. ❑Si n C1S rinkler ❑Demolilion �Chan e of Use <br /> DESCRIPTION OF WORK:��� �Q� S�1�_ <br /> -�UY <br /> ASSOCIATED SUILDING PERMIT# ff appiicable ; <br /> MECHANICAL PERMIT APPLICATION PLUMBING pERMIT APPLICATlON <br /> Type of ProJect: _New _ Addn Alteratlon Repalr Type of Project: _New Addn Alteratfon Repair <br /> #of �lst ol Rxfures #of <br /> Fixtures Fixfures Llst of Flxtures Flxtu es Llst of Plxfuies FI tui s L/st of Flxtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urinal <br /> Gas Pipinq Boiler Lavatory(Wash Basin) Dnnking�ountain <br /> Water Heater Refr( eratlon 5hower Floor Qrain <br /> Gas Fireplace Wood 5tove Kitchen Sink&Dis osal Grease Trap <br /> Gas Ran e Ductin 'Dishwasher Roof Drains <br /> Clothes bryer Hookups Other• Clothes Washer Madfcal Gas <br /> Ran e Hood Water Heater Other: <br /> Exhaust Fan Sink{Service/Bar/Mop/etc.) Other: <br /> $PttINKLER/SUPPRESSION SYSTEM <br /> Chemfcal or Water No.of Heads <br /> ACKNOWLEDGEMENT:/have ieviewed this applicatlon and confi�m fhe in/amation conlained herein is true and correcl.Work done pursuant lo lhis pe�mi!must comply with <br /> cunenf/ederal,state,and local law. The granting o/a permi(only au(horizes approved work and no devia(ions the�efrom,Deviations must lirsl be authorized in writing Irom�he <br /> Build/ng O�clal be%re being aufhorized under any circumstance.I am fhe owner,or/am eufhorized by fhe owner of Ihis prope�fy to perform fhe work/or which applrcafion is mado, <br /> and I comply wifh fhe State Contrecfors Law 18.27 RCW and 296.200A WAG � <br /> City of Everelt Of/icial Use Only <br /> PERMIT# <br /> uQ tz-t�l ��l 2' C�C� <br /> Ow eriAuthorlsad Age Signature Da4e (Ravised 9l23t209B) <br />