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EMN <br /> ®11 <br /> • PERMIT APPLICATIO• <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRI t KLER/ DEMOLITION <br /> EVERETT CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> WASHINGTON (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please): PROJECT,SITE:INFORMATION . <br /> PROJECT SITE ADDRESS: lL.�..� Lit-"r1t O/ . PROPERTY TAX#: O 1$ 1/ Y7 q 02-0Q0 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: :1-/.)0.1 (L_ ,,- 1c. l S TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET ,.), 30 ,L L( 1'1 'sr-7— 5 L <br /> 1 C=`` <br /> STATE ZIP l •'J( <br /> CITY` <br /> OWNER PHONE: (YL) ) . ) y 6 S^3> OWNER EMAIL:s.,'J4,0 i C.,/ �'7k'J ,r6 6 (.,,7 iC . C 0/1.7 <br /> CONTRACTOR NAME: 0 l'3 A Er <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ApWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: (Li2 j) v7,f--6J _ r <br /> 1- 1 L :1--u 4 R4. <br /> CONTACT EMAIL: <br /> BUILDING INFORMATION <br /> Existing Use of Building: ,,S t414 Contract Price of Work:$ ! paZf'L'' tsco <br /> Proposed Use of Building: S i"i Heat Source: ❑Gas Electric DOther <br /> BUILDING USE:XSFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: ❑Commercial DAccessory Structure <br /> Type of Project: ❑New ❑Addition /Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change off�U�se <br /> DESCRIPTION OF WORK: /L ../11 l�G!(' b 1 '�Z 1 c1,-'6 1'--)-C`�e'-" ((S"I`f') ( (.J Ir' /t dO`1.. <br /> r---\2 il-c 4r11 1 S 1"-1 13.4)t'"1 r4 -T- C 4,4 tq (1 74 C2.0i"7 ( 0/1 t-- e4L16 h1'o O/7-7 <br /> ASSOCIATED ING PERMIT#(if applicable): �� <br /> MECHANICAL-PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> fixture Fixture Fixture Fixture <br /> Count List of Fixtures count List of Fixtures Count List of Fixtures Count List of ures <br /> NC—Air Handling Units Gas Piping Backfl w Preventer(Inside Bldg) e Shower, ,or Combo <br /> Boiler Gas Range cis. es Washer Si ommercial(3-comp,prep,floor) <br /> 1 d` Clothes Dryer Heat Pump&Ductless if Dishwas S/ .ink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Founta / Sink-Utility,laundry,mop <br /> \ 1.1 Exhaust Fans(Residential) Commercial Ventilatior Floor Vain 1 Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Int eptor-Greas Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove I erceptor- d/Oil Water Service(behind meter) <br /> Forced Air Systems Other: ' Medic as Valves or Fixtures <br /> Gas Fireplace/Insert/Log f Drains / Water He <br /> SPPR1+NKLER%SUPPRESSION SYSTEM .----' Sewage Ejector or Sump Pump Other: <br /> Water Suppression Systeti No,ofHieads <br /> Chemical Suppression System - - No.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 <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.I am the owner,or I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Li cV. I-- ) rl—1_ y 012oo2- 0077 <br /> Q= er/Authorized Age 'Signature Date <br />