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PERMIT APPLICATION <br /> OSErrBUILDING / MECHANICAL I PLUMBING /SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettees@everottwa.gov I www.everettwa•gov/permits <br /> (Blttte or'Black Ink Only Please) . •PROJEGT%slrE°Ir'FOI ia;'T'It tv=-£ !- <br /> PROJECT SITE ADDRESS: -. Ct±I.I 171._ C'c. 1 <br /> ,t VV PROPERTY TAX#: <br /> LEGAL for new construction: Short F a9l„^,rr5diraion <br /> Lot No. (attach copy of long legal description) <br /> i TENANT CIN ----"al----"alCONTACT'INFORMATION <br /> OWNER NAME: 40 ' re. -- _,... ._.. ...,,.:. . <br /> cNAME(!t Commercial): <br /> OWNER MAILING ADDRESS: sFREE-, 111-41-7 ! J <br /> CIT'! 4 <br /> ST4Tt' f Zfp4. th <br /> 20 <br /> yyr —( <br /> OWNER PHONE: i a'' '' <br /> ✓ rte..,.? I 415/3 r <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: 4 IM ‘ n t(n C( <br /> CONTRACTOR ADDRESS: smeET 1 L torocttp J o <br /> r <br /> CITY <br /> 'Cry � t - ZIP Lg Q I <br /> : <br /> STATE <br /> CONTRACTOR PHONE: 42.5 �. © p CONTRACTOR EMAlt. rk Gif'1k :-fig. .GO'•�y,.Y <br /> - CON-TRAC-TOR-LIGENSEAREi UIRED): •- j„–,._ CITY-OF-EVERETT BUSINESS-LICENSE#(REQUIRED): (0Co i-rCit..._ <br /> PRIMARY CONTACT: 0 OWNER ( CONTRACTOR 0 OTHER(Please Specify)__ <br /> CONTACT NAME Toato,Le. CONTACT PHONE: 1....t..2.6 259 (:). 5.0 <br /> CONTACT EMAIL: • A. Lk i Co, <br /> `:emu)INGIAERMtT APPl3ioAtiot 2r:'; ;v A, ,:, <br /> Existing Use of BUIldinii <br /> Contract Price of Work:$ ! <br /> Proposed Use of Building: <br /> Heat Source as ❑Electric ❑Other <br /> Building Type: R-Detached ❑SFR-Attached ©pu { <br /> ney [;tkiultt rami }f <br /> y-#h Units ❑Commercial ❑industr'af <br /> Type of Project'` ❑New DAddition ❑Remodel ❑Re air ❑T.I. DSi,n OSprinkler ODemolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> U,_, C� S Ll 9n — <br /> ,ASSOCIATED BUILDING PERMIT#(if applfCahje): <br /> MECHAPlIGAL=PERMlT APPLICATION <br /> .;. 1-',:pL:UMBI1+l613ER.NII`T"t'Ah!F LI ATION <br /> Type of Project: —New Addn Alteration Repair <br /> #of Type of project: New ,AddnAlteration Repair <br /> – Firth bts�pEEtxfures _ .- #of #of <br /> xT 3'res LiSt.ALf;xt.,,, s Gf81-0tRixfure5 #of <br /> Fixtures' kirFot Fixtures — . <br /> A/G–Air Handling Limits Heat Purr. Fixtures <br /> Forced Air Systems Toilet —Backflow Presenter(Inside Bldg) <br /> Unit Heater Bathtub <br /> Gas PipingMoiler �t.Jfinal <br /> Water Heater Shower <br /> Wood Stove Floor Drain <br /> Gas Range t �Kitchen Sink&Disposal r Grease Trap <br /> Clothes On er Hookups Jutting Dishwasher <br /> Ducting <br /> Other. Roof Drains – <br /> Ranse Hood <br /> Mill Washer Medical Gas <br /> Other: <br /> Exhaust Fan <br /> MIIII Sink Service/Bar/Moe/etc.)....oe/etc.} Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No' <br /> No, of Heads <br /> 11111111111111111111111111111111111111111111111111.11111 <br /> ACKNOWLEDGEMENT:I 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,stale,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 far which application is made, <br /> and I comply with the State Contractors Law 18.27 ROW and 206.200A WA C. <br /> City of Everett Official Use Only <br /> F.77-7. "$ <br /> Owner/Autltorized AgeSignatureur '� <br /> g i 0' ,L <br /> Date <br /> (. (Revised 9/2 2016) <br />