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I <br /> PERMIT APPLICATION <br /> 477BUILDING 1 MECHANICAL/ PLUMBING 1 SIGN /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@everettwa.gov I vwaw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:-7(T) I D8rd ..RL S6. t (p <br /> PROPERTY TAX#;� <br /> LEGAL for new construction: Short Plat/subdivision <br /> ^� Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION ~ <br /> OWNER NAME:&AI 'lrht 1 TENANT NAME(If Carnmercial): <br /> OWNER MAILING ADDRESS: STREET'--1(51 1 fLG6 <br /> CITY owe STATE WM. ZIP 41/VOK <br /> OWNER PHONE. , lb• r,.., OWNER EMAIL: <br /> CONTRACTOR NAME: UJ/4-501 Af6j rbfLi r f , 7t a_ 1-46-76:76g5- <br /> - <br /> CONTRACTOR ADDRESS: STREET 1l7!S Z ((b tik e C — PG ADX 592.6 g <br /> cm, Wert.Yl J 64 STATE (A f3- ZIP I f )5g <br /> CONTRACTOR PHONE: 42' -g-K3- /7/ 'CONTRACTOR EMAIL: (1J J v,}' (44nitinLd Corn <br /> CONTRACTOR LICENSE*REQUIRED): ( 4-54 ve-OP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 4CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME,;,.._/j y� ( CONTACT PHONE: c'2- -g'g3_ca 7/ <br /> ""' '(- /5 CONTACT EMAIL: w,y-cm-Hc i-g_@ C .Ow <br /> ¢, BUILDING PERMIT APPLICATION <br /> j <br /> Existing Use of Building: f A.M(G Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: �,6}s [] <br /> a�, ytla$ EiectnC ❑Ottte <br /> Building Type: ICISFR-Detached 0SFR-Attached ❑Duplex ❑Multi-Family-#of Units: <br /> y _ ❑Commercial Olndustri '.'s <br /> Type of Project ❑New °Addition DRemodel DRepair OT,I. ❑Sign ❑Sper ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: Sprinkler <br /> geirtiLL Q4--lee.-4/46L— i 0 ai aiditv-hili-e6, --) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION \ PLUMBING PERMIT APPLICATION <br /> A. <br /> Type ofProject: __New _ Addn Alteration _. Repai T <br /> #of _fType of Project: `New Addn Alteration `Repair T <br /> Fixtures of Fixtures #of List of Fixtures of i! <br /> List <br /> Fixtures Fixtures List of Fixtures List of Fixtures <br /> A/C—Air Handling Units Heat Pum Fixtures <br /> P Toilet UrinalBackflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub <br /> _Gas Piping _Boiler Urinal <br /> Water HeaterLavatory(Wash Basin) Drinking Fountain <br /> - Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Range Ducting Dishwasher p <br /> Clothes Dryer Hookups -Other: MdDrains <br /> Range Hood Clothes Washer Meedical Gas <br /> Exhaust Fan _Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER 1 SUPPRESSION SYSTEM <br /> • <br /> JNumber of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the r�nformatron contained herein is true and correct. Work done pursuant to Ibis permit must comply <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 wilting from with e <br /> Building Official before being authorized under any circumstance,I am the owner,ort em authorized by the owner of this property to perform the work for which appibeh'vrr is made, <br /> and t comply with the State Contractors Law 18.27 RCW and 2 200A WA C. <br /> LA4 <br /> + Gity of Evarett Official Use Only <br /> J t/2 7 7 I PERMIT,, n Ad'' 04 <br /> Owl erl ithorized Agent Signature IV ' <br /> Date (Revised 5120/2076) <br />