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1110 PERMIT APPLICATION• <br /> #14P:----, A BUILDING t MECHANICAL t PLUMBING I SIGN/SPRINKLER t DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-2S7-8810 I FAX 425-257-9857 1(E)everetteps@voevettwa.gov 1 worw.everettwa.govipermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: _';iC.7. I(11, 5r PROPERTY TAX#: 5� L/ l J(j/O�y <br /> LEGAL for new c struetion: Short Plat/subdivmsion Lot No. (attach copy of long legal description) <br /> Vie/ CONTACT <br /> iNFORIVIATION OWNER NAME: 1--err f ff te /LL rr a 9 TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET 3oc2;- 16 -t S. r <br /> , OWNER EMAIL: <br /> PHONE: CIcl s 7/� rI <br /> CONTRACTOR NAME: 0(.t;/I1.4(� <br /> CONTRACTOR ADDRESS. STREET <br /> i;,l'rY' STATE ZIP <br /> ONTRACTOR PHONE: CONTRACTOR EMAIL:TRACTOR L10ElltSE;ik(F�EOUtREB) ICITY OF EVERETT RUMNESS LICENSE#(REQt1URED): <br /> 14 <br /> ARY CONTACT: 0 OWNER 0 CONTRACTOR iSODTHER(.Please Speofy) jle 5/p cl/" <br /> CONTACT NAME:J //�/ CONTACT PHONE: U6/ '- 1/7f d. - `�-7 / <br /> (re- W(7JI J-f/i(L CONTACT EMAIL: ( C7C7 .v[eS `9 fii Licit, CUP-7 <br /> BUILDING PERMIT APPLICATION <br /> 'sting Ilse of t3ulidirrg: Corttract price of iN 5 C h�l <br /> Proposed Use of Building: i71%e.//�a Heat Source: OGas er <br /> Building Type: '' =tached OSFR-Attached ❑Duplex ❑Matti-Family-#of Units: EICornmercial (3 ndustriat <br /> Type of P a. • it New ■ •ddition ❑Remodel °Repair (JT.I. °Sign ❑Sprinkler ODemolition °Change of Use <br /> DESCRIP • OF WORK: <br /> lExt <br /> n,e -- Zo iQ..G1 I,r .vati.e it1('-ft9 ,W'f t.tlist //3 <br /> SSOCIA. t . a ING PERMIT#(if applicable): <br /> IT MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> ype of Project: >0 New i Atkin Alteration _Repair r Type of Project: Ip New Atkin _Alteration _Repair <br /> Fixtures List of Fixtures X � List of Fixtures Fib List of Fixtures Fjxtu�s List of Fixtures <br /> FiurA/C—Air Handling Units Heat Pump I Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater I Bathtub Urinal <br /> Gas Piping Boiler ( Lavatory,(Wash Basin) Drinking Fountain <br /> / Water Heater Refrigeration s 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 /> I Range Hood Water Heater 4 Other: (� J <br /> I. Exhaust Fan Sink(S�vicelS lt►Aa1PJetc. Other: <br /> i I <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water 7 iNo.of Heads • 1 + i <br /> ACKNOWLEDGEMENT:t have reviewed this application and confirm the information contained herein is live and coned.Work done pursuant to this permit must comply with <br /> current federal,state,and local raw.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,or lam authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the Stare Contractors Law 18.27 ROW and29620OA WAC <br /> City of Everett Official Use Only <br /> i <br /> ..� `J . - /S u Zoe P 2oc 002 <br /> OwnerlAu th Agent Signature Date (Revised 9/23/2016) <br />