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PERMIT APPLICATION <br /> ,�/� BUILDING I MECHANICAL/ PLUMBING/SiGN/SPRINKLER I DEMOLITION <br /> tigi- <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> .� ... �->. r:; .A.�,.ri.,.. .�_- nom.-..„-_,..5 .�,.. <br /> � __:-t ._k .w .<��:,::;_-��PROJECT S TE 7NFORN(ATION-,..... .}::; . �.. _..__ L s __._, <br /> PROJECT SITE ADDRESS:477 7 Spr^ /4 ,, PROPERTY TAX#: 00 c c ay00 z 0/g" oO <br /> LEGAL for new construction: Short Plat/subdivision /� Lot No. (attach copy of long legal description) <br /> Z r >4, CONTiACT INFO:tMAT10N. .._ ttV' g angg4 h_. _. ' <br /> OWNER NAME: Oe h h l S 4-. We i -4-el- TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 47(7 5 if f'' At J <br /> cm/ Fite Ir . STATE tact ZIP ?V 2 0. ry <br /> OWNER PHONE: 42-c -j ` <br /> 0f O ?41 OWNER EMAIL: ya <br /> lPt141 v@ l' 2 <br /> a010 �trro¢w44tt/-fc1-t. <br /> CONTRACTOR NAME: C)14,u.4 se- <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: Y-2-C-S-0/ ^027 CONTRACTOR EMAIL:Vjoplvt,V 7 cs'2 ciO tOli6tt,i wi(- 'G1.4 <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED): <br /> PRIMARY CONTACT: VOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 42 c .00/ —074"9 <br /> Vetihii Al 114- CONTACT EMAIL:tit of,lyt i/ e_o(/ /1671 is// CcdG <br /> . ti _. Z.. _.NOxti"BU1 WITOrati ttf 1 APPLI0-# . _ `g �� w_. .,.. _._T <br /> Existing Use of Building: gecdek T/A ( Contract Price of Wor :$ /Oj 6 00 "f v6 3 2,_,C) <br /> Proposed Use of Building: Ices tjgrn4i;,1 Heat Source: 0G.. SElectric P Other <br /> Building Type: FR-Detached CSFR-Attached ODuplex DMulti-Family-#of Units:. r ommercial ❑Industrial <br /> Type of Project ONew OAddition PRemodel DRepair 0T.1. DSign OSprinkler Et:-molition ❑Change of Use <br /> DE CRl TION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 1 4100.,4 CAL PERMIT APP,JCATION`_-., r i .' ; r r, at.PLUMBING;PERMITiAPPLiCATION ',;,' __`ESI_ <br /> Type of Project: New_ Addn Alteration _Repair •e of Project: _New Addn Alteration _Repair i <br /> #of #of #of - #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures t of Fixtures Fixtures List of Fixtures ; <br /> I <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) i <br /> Forced Air Systems Unit Heater Bathtub Urinal 1 <br /> Gas Piping Boiler Lavatory(Wash B.__in) Drinking Fountain 1 <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher - Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: B <br /> ;, Exhaust Fan Sink(Service/Bar/Mop/etc.) 0 --r. <br /> i <br /> mag <br /> SPRINKL ER=/SUP004104 SYSTEM_ <br /> Number of Heads <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 1 <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.lam the owner,ori am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200,4 WAC. <br /> City of Everett Official Use Only <br /> Z- 9 AZ—/<--- Z0(7 , t2 f <br /> Owner/Authorized Agent Sig uf�( Date (Re 0/121209 <br /> V <br />