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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�425-257-881t� j FAX 425-257-8857 � (E),�v�r�ttep��e��ret�v�,�.yc�v � �nnvw,everettwa.govlpermits <br /> (B1w+� or Black it�k Q�i�r please} PROJECT 31TE INfORMATtON <br /> PROJECT SiTE ADDRESS: '�Z� �Vi;e,��f��±'( �^�/'L.' S� �VGR�i"�I^Qg� pROPERTY TAX#: ��rt,.,���Q��""[ ' <br /> LEGAL for nev3 cansrr:aet;�n: Shnrt Piairsubaiv:s�ori� _ i..r�Nu._---_ (attach cepy o�long legal descriptionj <br /> CONTACT iNFORMATION <br /> oWNER NAME: � TENANT NAME{if Commercial): <br /> OWNER MAILIfVG ADDRESS: srrze�r �,.'L'L(} fr, � �t �'� <br /> ...m». d..���Y v.r�� :.IFi�'�"��� /�(> <br /> OWNER PHONE: TU� � ��4 � t�{} OWNER EMAIL: 'Wl�.-.M 1 e � �/l.D�f'3'IQ,�� • �OYI� <br /> CONTRACTOR NAME G'D,� �7�/�/� �(��/N(� J A/C. <br /> CONTRACTOR ADDRESS� srR�F, 17"G•�� IS� �u�'iyt„E,,t� �'+�c � �),� <br /> c:i�: c�7"",j� L.�— ,:;,;-. w�- 9��"�7�,. <br /> � �,F <br /> �ONTRACTOR PHONE: �„7�..- ,��'-_. CONTRACTOR EMAIL: �r/ ,��Q,/�/ �7�ff�/�r�� - <br /> :ONTRACTOR LICENSE#(R�t�UIRED): �'Q�Q/�/��Q,2'��;,t�'� C1TY QF EVERETT BUSINESS UCENSE#�REQUIREC�}; D3�'G <br /> �RIMARY CONTACT: ❑pWNER [�ONTRACTOR ❑ OTHER{Please Specify)__ _ <br /> ___�._ � �._ <br /> :ONTACT NAME: CONTACT PHONE: .t���-_.S/BS--D/// <br /> cSAR�} GORNlS�, OF��C�' mA�v�4GF� CONTACT EMAIL:KY�i�,� �,��it'�'Trxv�t��'>v�.� <br /> BU�LDING PERM�T APPLICATtON <br /> ���IFrE€�Use of FSuil�fta7y, ��,�f � � � Contract Price of Workx$ 1 �,+t��7 ���� <br /> 'r��x;�;�c��Use of Buildin+� Neat Source: ❑Gas ❑Electric ❑C.�ther <br /> 3uilding Ty�e SFR-Detached ❑SFR-Attached ❑Uu,tex ❑Multi-Famdy-tl of Units ❑Commercial ❑Industrial <br /> y{:.c, of Pro}Ect CaNew C1Addition ❑Remadel ❑T.l. C,1Su�r? ❑Sprrnkler ❑Demolition ❑Ct�,�n �of Use <br /> )ESCRIPTION OF WORK: <br /> �emou�e. �ompos i�rn� Ro�eng b Ply�+x�cr',y � �e�t�-e wi�`h G�crn��Po�r�-r ��'�� <br /> �SSOCIA7ED BUILDING PERMtT#(if a 7iicable <br /> MECHANICAL PERMIT APPLICATION PWMBiNG PERNIIT A,PPL1CATfON <br /> ype of Praject: _New _ Addn Alteretion Repair Type oE ProJect: New _Addn _Alteration _Repair <br /> ii of �#of <br /> =ixtures List of Fixtures Fixtures List o/Fixtares #of List af Fixtures #of L1s2 of Fixtures <br /> Fixtures Fi�ctures <br /> A!C—Air Handlin Units Heat Pump Toilet 6ackflow Preventer(Inside Bld ) <br /> Forced Air S stems Unit Heater Bathtub Urin21 <br /> Gas Piping Boiler Lavator (Wash Basin) Drinking Fountain <br /> Water Heater Refri eration `Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Ran e Ducting Dishwasher Roof Drains <br /> Clothes Dryer Haokups Other Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Mo letc. Other. <br /> SPRiNKLER 1 SUPPRESSION SYSTEM <br /> t�umber nt H�ads <br /> CKNO WLEDGEMEN T 1 have reviewed fhis applicalion and conlirm fhe rnfomialicn cantained herem is true and conect WoAr done pursuant to this permil must comp/y with <br /> �r!ent federal,state.and�oca!!aw The granting o/a pe�md only author¢es approved worH and no deviations lhe�efrom Deviations must irrst be authonzed in wnting(rom the <br /> ,ildhry G�c�al be/ore+aerng aulhonzed undor a�ty circumstance I am fhe uwner w I am autherized by the owner ot tt,rs prapert y!o periorm fhe work for which application rs made <br /> �d 1 cornp(y wrth the State Cc3ntrac?ors Law 18 27 RCW and 296 7GOA WAC <br /> City of Evereit Official Use Only <br /> . �'A't.�tsa�(.a° I[/ +�J�� PERMIT �� � �1 <br /> wner AuCno�fa�gent Signature �--�CJaif � � f <br /> fRev7sed 5/20I20i't�) <br />