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PERMIT APPLICATION <br /> Oi*ErrBUILDING / MECHANICAL I PLUMBING!SIGN I SPRINKLER! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everetNva.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT StT;E INFoRMA IGt ' ,; ; r• <br /> PROJECT SITE ADDRESS: I(92c61.47) -V-4 ' <br /> LEGAL for new construction: Short?latisut;i;, PROPERTY TAX#: q <br /> tisItan Lot No. attach copy( of long legal description) <br /> CON'TACT4INFORI4IIt TIO C <br /> OWNER NAME: _ <br /> rt l TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY AI ...+ �� �� ;� <br /> ' -.. <br /> s y.�^+y + t.r 82,0Lek .Q- .' STATE ( zip �,8 I <br /> OWNER PHONE: 2.5 ( 2 f <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: ' in 1n C <br /> CONTRACTOR ADDRESS: 57REETi t 5 .aa z <br /> XJ a.L1CTY e ,e / <br /> STATE vo f"- LIP ctg,20 1 <br /> CONTRACTOR PHONE: 42_5 S)a 050 CONTRACTOR EMAIL' <br /> _ _ co <br /> nt-T-t�a�c�rac�-t�tcNslw�;f�E,�u,REt�): _ �'.-��'� s �#Yl,�' f(1.� .coal", .: t+tTY v ....st E33-tic NsE tRE uTRED -fob' `.. <br /> g <br /> PRIMARY CONTACT: 0 OWNER b CONTRACTOR 0 OTHER(Please Specify) <br /> CDNTACT NAME: <br /> CONTACT PHONE: ��I,. „2��. z5c/ Ot t=t -0 <br /> CONTACT EMAIL:�-�n G,1.,a C.!WL! Ir____"]"'L,/ Co rv7 <br /> d:. BUILLi <br /> - ING?'pPERMfl *FT,pow.lQN `"("x:* .a',,W :rE=T <br /> Exf�tJn9 Use of Stafdins: <br /> Contract Price of Work:$ d a <br /> Proposed Use of Buiidth+: <br /> Suildin. T a: ,v Heat Source: as ❑Electric ❑Other ___ <br /> p f FR-Detached ❑SFR-Attached ❑Druplex ❑Multi-Famil 4 or nits' <br /> Te of Project; ❑New pgddition ❑Rp ❑Commercial El Industrial <br /> DESCRIPTION OF WORK; mode! ORa fir ❑T.i. 034 ❑Sprinkler I]Damalition 0Ghan.a of Use <br /> ?\tp‘of\ce &AS nac e <br /> ASSOCIATED BUILDING PERMIT#Of applicable): <br /> MEGHAIdicAl.`PERtvltr APPLICATION .,: <br /> Type of Project: New Addn '=�' �°I~i1MB1l�iG'.�L�RNiIY`l't(t�,P.LICA'1'ION <br /> Alteration Repair <br /> #of Type of Project: —Addn gttaratlon <br /> fxturas FTti7ri Ltstol Flxtzrres—- <br /> _ #of —Repair <br /> NCMMIIINII — ix e�. UatatFl�Ptu es #of <br /> Air Handlin Units Fixtures List affix-tures- <br /> - <br /> fFix-tures ..: ... ..... <br /> !teat Pump Toilet <br /> 1.11111111 Mil Forced Air Systems Unit Heater Backflow Preventer fnslde 81d 1 <br /> Gas Piping <br /> 3athtuta Urinal <br /> Boiler t auato Wash Bashi <br /> MINrIMMIRe(rl�eialirart ) Drinktn. Fountain <br /> Gas Fireplace <br /> Shower Floor Drain <br /> Gas Rang° ;N W°vd Stove kitchen Sink Ois.vsat <br /> Clothes 0 er Hookups Ductin. Grease s <br /> 1111111.1111 <br /> MUM <br /> Dishwasher Roof Drains <br /> Ran.e HoodMIN Clothes Washer Medical Gas <br /> ����� 1` Water Heater Other: <br /> 11111.11.111.1. Sink(Setvtce13ar1Mo•letc. Other; <br /> SPRINKLER'/SUPPRESSION SYSTEM <br /> MIChemical or Water <br /> No, of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this app/,cation 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 lam 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 mane, <br /> end!comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> rhe City of Everett Official Use Only <br /> i LA <br /> 1 <br /> Ow.erl 0_Ar land Age •s-- f 1 - I/ l` 1 . •' _ /' <br /> 9 Signature o o <br /> CEJ <br /> Dale (Revises:0123/2016) <br />