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PERMIT APPLICATION <br /> 0,1577. BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps d(ieverettwa gov I www.everettwa.gov/permits <br /> (Blue or'Black Ink-'Only Please) PROJECT!SI"l;1 IN1 O,€t>}fli TION kr"`:Y <br /> PROJECT SITE ADDRESS: 7 '"-,i"jr C e <br /> 'w'�.ti `~""'t J PROPERTY TAX#: I <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lot No.' (attach copy of long legal description) <br /> C't N" ACtii*ORMAtioN '' <br /> OWNER NAME: \let\rit:.ceifr,n tc 0.S' <br /> TENANT NAME Of Commercial): <br /> OWNER MAILING ADDRESS: STREET I > ,04 Of r„ eet. <br /> C" l �' """ STATE WeA <it ao <br /> j t +�� ZIP <br /> OWNER PHONE:"t 25 350 f (e OWNER EMAIL: <br /> CONTRACTOR NAME: CPI cMn �nL <br /> CONTRACTOR ADDRESS: STREET t`T I:.✓1 ©cuck,L <br /> CITY J �tN1� (�,� ��{7(�2,0 �. <br /> ^y STATE �rt ZIP gI <br /> CONTRACTOR PHONE: �4c5 2!3ci O .7)60 1CONTRACTOR EMAIL: ,( )Cs . c-v Th , 0-111,13 GDS <br /> CON-TRACTOR-L4OENS~#tftECU+RED)rf-� 9 r + r 1 <br /> �-^'r �-yt t"S CITYOF-EVERETT>3u$1NE$S LICENSE#(REQUIRED) 106,CI <br /> PRIMARY CONTACT: ❑ OWNER (CONTRACTOR ❑OTHER(Please Specify) _ <br /> CONTACT NAME: CONTACT PHONE: 4.2.6 25 C7 0550 <br /> D CONTACT EMAIL:de.b.)0a 'ems cA ` ratr,.y,i cot <br /> �- INCs;PeltRI11''1"I=A�i��it�"i'�i"Y'iCF� �..�':_`- -,�.a`Fr`�`., ,�: ,.. - , , <br /> Existing Use of Duildin.: Contract Price of Work:$ ! 6 <br /> Proposed Use of Buiiding: --� .. <br /> Heat Source: s ❑Electric ❑Other <br /> Buiidin Type: _._ ,. <br /> 9 �R-Detached ❑SFR-Attached ❑Duplex ❑Multi-FarnIly-.1 of nits: ❑Commercial ❑Industrial <br /> ape of Project: ❑New ❑Addition ❑Remodel I❑Repair ❑T.I. ❑Sign ©Sprinkler ❑Demolition ❑Chane of Use <br /> DESCRIPTION OF WORK: <br /> (r1.5-f-aul GAS t G,nd 7.uxi as- ?l p►n im t%'ise1 <br /> ASSOCIATED BUILDING PERMIT# iia phi' <br /> iCa t7ia}: <br /> MECHANICAI.PEFtMIT.LtP,PL ICATiON : -' <br /> '`";PL1JMBtNG`pERM. i�A ?E�l CC1><"i'., <br /> Type of Project: New Addn Alteration ,_._-Repair f <br /> (f of Type of project: New Addn Alteration iRepair <br /> -Mxtzrres° L t.=eLFlxlctres__..__ #of #of #of <br /> FlkFures moist.nt7xxures F list-01-Fixtures—..— <br /> Fxfu --List of-Fdxtrrrs _ __._._ <br /> AIC-Air Handling units Heat Pum f Fixtures <br /> torted Air Systems p Toilet �� Backflow Preventer(Inside(aid ) <br /> Unit Heater Bathtub <br /> CaaS Ppptng t3oier U(inal <br /> WaterWater Heater La�+atory�tNash Basin Drinking Pauntain <br /> Fireplace Refrigeration Shower <br /> Gas 1Ncod Stove Floor Dr in <br /> „_.�____ Gas Flange KJichen Sink 8 Dfsposat Grease Tia <br /> Ducting Dishwasher <br /> Clothes Dryer Hookups Other: Medicarairls <br /> Ran r�Hod Clothes Washer Medical Gas _ <br /> Exhaust Fan :_- _ Water Heater Cytl�er. <br /> Sink(Service/Bar/Mop/etc) Other. <br /> SP IPiKLER'1-SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the information contained herein Is true and correct.Work done pursuant to this permit must comply m with <br /> current federal,state,and local law.The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorized in wilting frothe <br /> Building Official before being authorized under any circumstance.i em the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the Stale Contractors Law 1a27 RCW and 296.200A WAC. <br /> /� <br /> Q City of Everetf Official Use Only <br /> .+A...t Q 4 - 0 - t U PERMIT# <br /> Ow,erfAuthorized Age Sgn ture� ��"� � � <br /> C ' Date <br /> (Revised d'"""'x2, 078) !-.._._._.�_ <br />