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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 /> (F}425-257-8810 � FAX 425-257-B857 �(E)evereltepsQev�reStwa.$ov� www.everettwa.govlpermits <br /> {Blue or Black Ink Only Please� PROJECT SITE INFCiRMATIQN ' <br /> PFtC3JECT SITE ADDRESS: �O �Z��` ��,,#' T �j� W I�� PROPERTY TAX#: <br /> I.�GAL for new construction: Short Plat/subdivlsion .`�ot No.� (attach copy of long legal description) <br /> CONTACT INFGRM/�TION <br /> OWNER NAME: �� TENANT NAME(If Commerclalj: <br /> QWNEF�MAILING ADDRESS: sraeEr �'} � � �I O7"" <br /> CfTY �J��a.� STATE �'- ZtP Q <br /> 'OWNER PHpNE: � �" �(,�r OWFiER EMAIL: <br /> CONTRACTOR NAME: y�� <br /> CONTRACTOR ADDRESS: srReEr �� (,j�„�,(q,� <br /> c�rr sTnrE � xtt� � <br /> CONTRACTOR PHONE: ��, Q � CONTRACTOR EMAIL• �"� ,�(� <br /> Ct7FNTRftCTL}R 1.fGENBE#tFtEC3UIRED}: Cli'YOFEV�ii�fT BUSINESS i.ICE�iSE#(ftEGiUiRED). �}�+Q A <br /> 'PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CI�NTACT NAME: �� CONTACT PHONE: (�.'�C� 25� O5� <br /> � <br /> CONTACT EMAIL: � �� ,� <br /> ` BUIl:DING'PERMIT APPLtCATiON <br /> Existin Use of Bui(d(n ; Cantract Price of Work;# �-�'�.�•�3 <br /> Prc� nsad Use of Buildi � Heat Source: Gas ❑Electric ❑Other <br /> E3�Filding T m: SFR-Detached ❑SFR-Attached ❑duplex ❑Mult!-Fariiil -�of Units: ❑Commercial ❑Industrial <br /> Type of Pro'ect: ❑New ❑Addition ❑Remodel ❑Re air ❑T.I. ❑Si n ❑5 rinkler ❑Demolition ❑Ch�n e of Use <br /> DESCRIPTION OF WORK: ��� �Q� ���� A �,�� <br /> Y VC.�ti.�C <br /> ASSQCIATED BUILDING PERMIT#(If applicabio}: <br /> MECHANICAL PERMIT APPLICATICN PLUMBING PERMIT:APPLICATION <br /> Type of ProJect: _New _ qddn _Alteratlon _Repalr Type of ProJect: New _Addn _Alteration Repafr <br /> !F of ��st of F/xtures #of <br /> Ffxtures Fixfures «st oI Flxtures F(xfu es Ust of Fixtures Flxtures Ust of Ftxtures <br /> A/C—Air Handlin Units Heat Pump Toilet Backflow Preventer Inside Bld � <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler �avatory(Wash Basin} Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen S}nk&C?is asal Grease Trap <br /> Gas Ran e Ductin Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(SarvicelBa�lMe�pletc. Other <br /> 8PttINKLER!SUPPRESSION SYSTEM <br /> Chemicai or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have revlewed this applicafion end conlirm fhe in/ormation conlained hereln is frue and correct.Work done puisuant to this permif must comply with <br /> cutrettt federal,stale.and lacal faw.Tha granti�rg of�permit only authorizes epproved work and no devlafions iherefrom.Dev/aflons mus(firsf be authorized in writing from fhe <br /> E�ualdi»g nrticial beicrra being aUtttorized ur�dsr any crrctrmstance.1 am the owner,or 1 am authorized by the owner of thrs properly to perform fhe work lor which application is made, <br /> and 1 compfy wilh the State Contractors Law 1827 RCW and 296.200A WAC. <br /> Criy ol Everett OHicial Use Oaty <br /> PERMIT <br /> � �� ��3-�� �'1 � � - o3g <br /> Ow sr1Aulhorizas!Age Slgnature D�t� Redlsad 9123f2076} <br />