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II II'' II PERMIT APPLICATIO IPRINKLER /DEMOLITION BUILDINJAECHANICAL / PLUMBING / SIGN <br />CITY OF EVERETT PERMIT SERVICES <br />OL 3200 CEDAR STREET, EVERETT, WA 98201 <br />(P) 425-257-8810 1 FAX 425-257-8857 1 (E) everetteps@everettwa.gov I www.everettwa.gov/permits <br />CONTACT."INFORMATION, ., <br />OWNER NAME: &ILL JS TENANT NAME (If Commercial): W- <br />OWNER MAILING ADDRESS: STREET <br />CITY E 1 L167T STATE zip <br />OWNER PHONE: OWNER EMAIL: <br />CONTRACTOR NAME: Patriot Fire Protection Inc. <br />CONTRACTOR ADDRESS: STREET <br />ciTY Tacoma STATE WA zip 98424 <br />CONTRACTOR PHONE: 253-926-2290 CONTRACTOR EMAIL: ��+�1(� Q :��[ ; k a r'e < <5y�••• <br />CONTRACTOR LICENSE #(REQUIRED): CITY OF EVERETT BUSINESS LICENSE #(REQUIRED): 024694 <br />PRIMARY CONTACT: ❑ OWNER ® CONTRACTOR ❑ OTHER (Please Specify) <br />CONTACT NAME: CONTACT PHONE: 3� y b <br />CONTACT EMAIL: <br />BUILDING -PERMIT APPLICATION , , .,., <br />Existing Use of Building: Contract Price of Work: $ <br />Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br />Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex []Multi -Family-# of Units: Commercial ❑Industrial <br />Type of Project: ❑New ddition Mernodel ❑Repair 11T.1. ❑Sign Sprinkler ❑Demolition ❑Change of Use <br />DESCRIPTION OF WORK: <br />JN.%TALL Illsr..j WLT Sl5Tt_1M PAI L-te %S' %AJC- ISJ1L\01AJC_ A-0 <br />ASSOCIATED BUILDING PERMIT # (if applicable): <br />PLUMBING, PERMIT APPLICATION <br />Type of Project: _New _Addn _Alteration _Repair <br /># of <br />Fixtures <br />List of Fixtures <br /># of <br />Fixtures <br />List of Fixtures <br />Toilet <br />Backflow Preventer (Inside Bldg) <br />Bathtub <br />Urinal <br />Lavatory (Wash Basin) <br />Drinking Fountain <br />Shower <br />Floor Drain <br />Kitchen Sink & Disposal <br />Grease Trap <br />Dishwasher <br />Roof Drains <br />Clothes Washer <br />Medical Gas <br />Water Heater <br />Other: <br />Sink (Service/Bar/Mop/etc.) <br />Other: <br />ACKNOWLEDGEMENT: / have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br />current federal, state, and local law. The granting of a permit only authorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br />Building Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which application is made, <br />and I comply wit e Co ors Law 18.27 RCW and 296.200A WAC. <br />City of Everett Official Use Only <br />PERMIT # <br />w r/Authorized Agent Signature ate (Revised 512012016) <br />