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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL/ PLUMBING I SIGN /SPRINKLER I DEMOLITION
<br /> AlliliP°./.14"/4::‘
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> liorigi 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8310 I FAX 425-257-8857 I(E)everetleps@everetiwa:goy I www.everettwa.gov/perrnits
<br /> (Blue or'Black Ink"Only Please) 'PROJBGT'SiT,E4II404 MATIC1�1�`� 7 raY ',;'', '.
<br /> PROJECT SITE ADDRESS: a2,'32,. F .,t- Ave,
<br /> PROPERTY TAX!#;
<br /> LEGAL for new construction: Short Platisii8dtyia,00
<br /> lot No.' (attach copy of long legal description)
<br /> CONTACT 14FORMAtION , - ''.. .< "
<br /> .............................7
<br /> OWNER NAME: ti+' 2
<br /> tS 1
<br /> TENANT NAME(If Commercial);
<br /> OWNER MAILING ADDRESS: -=rvia i
<br /> OWNER PHONE: - I Via, ,
<br /> €4.)eiL.CorX SIAM LOCI `220
<br /> , , C, OWNER EMAIL:
<br /> CONTRACTOR NAME: i to In L
<br /> CONTRACTOR ADDRESS: srP.=_..T 14ror0�- .�E , . .
<br /> O re a,J' ,/ t.
<br /> tV t-t.t.L�.L1 w
<br /> STATE zea g k 20 1
<br /> CONTRACTOR PHONE:
<br /> 2F3 q 0550) CONTRACTOR EMAILA jai/Ci I . cneonsa con
<br /> ___ _GONTF�+4C O I;IGENS #RE 3UlREt3}:�..t4i }
<br /> lit r t�rtr. ''t- I Cfretnt-L'VelkI!'79`' ratNeSSTICEN5EAREQQUIREDI- b
<br /> PRIMARY CONTACT: 0 OWNER I CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> ^'^c^ CONTACT PHONE: L,E 2.,GJ 2:541- {_,, C
<br /> �i�J CONTACT EMAIL: es Jam/t.� "1": Cs..11"1'�.kecx, .co rvi
<br /> - EFtMtt4toitl1t0101474 4..=A�°`xnn ,,:-, � . .,
<br /> Existin. Use of Buildin+: ,
<br /> Contract Price of Work • 001.0
<br /> 'a.3sosed Use of B Win
<br /> Heat Source: • as ❑Electric Dot er'
<br /> Building Type• `SFR-DetavheJ ❑SFR-Attached ODuotex ❑Multi-Famiiy4 of Units:
<br /> 7
<br /> Type ofP,oJ: ❑New ICAddition DRemodel OReOCom rcial ©Indu3tr:�
<br /> DESCt' IPTION OF WORK: �7�7�,, atf ❑T.I. ❑5i n � •rinkler ft,temolition ;•9 ktln n of Use
<br /> 11x, 1 + c �t,„ ...„,,,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL:=P"ERMIT APPLICATION ` _
<br /> '' a.} UMB1N-GtjEpM •
<br /> iAP LId
<br /> ATICNType of Project: _New Addn
<br /> Alteration Repair Type of Project: _New Addn _Alteration _Repair
<br /> #af
<br /> —, tyzfurss-•„_—j,ts IFlxtttraS #of f«of
<br /> FfIJs LfsfaitrF{xfu et-•—..._, Listlf>~JXttracs if of
<br /> A/C—Air Handling Units Neat Pum Fixtures Fixtures —List-of-Fixtures
<br /> Forced Air systems p Tailet Backflow Pre+renter;(Inside Bldg)
<br /> Ga-2'"1- 19---------
<br /> s PingHeater Unit Heater Bathtub Urinal
<br /> boiler
<br /> Lavatory ,
<br /> Water Refrigeration ry(Wash Basin) Drinking Fountain
<br /> Gas Fireplace Shower Floor Drain
<br /> Wood Stave Kitchen Sink&Disposal Grease Trap Gaan a Ouetn
<br /> Glralhes D er Heiakup, Dishwasher Roof Drains
<br /> Ran a Hood Other: Clothes Washer Medical Gas
<br /> Exhattsl Fan Water Heater Other.
<br /> Sink servicelBarlMc�+Jelc. other_
<br /> •
<br /> SPRINICEDER1SUPPRESSION SYSTEIVI
<br /> Chemical or Water No.of Heads
<br /> ACKNOWLEDGEMENT:f have reviewed this application and confirm the information contained herein Is true and correct Work done pursuant Ic this permit must comply with
<br /> current federal,state,and!ace!law.The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> lidding Off cla!before being authorized under any circumstance.I am the owner,or!am authorized by the owner cf this property to perform the work for which epplicaticc is made,
<br /> and!comply with the State Contractors Law 18,27 ROW and 296.2GOA WAC.
<br /> City of Everett Official Use Ont?
<br /> Ow,sr/Authorized Age Signature
<br /> cote
<br /> (Revised 9/23121316)
<br />
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