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PERMIT APPLICATION <br /> BUILDING&CHANICAL / PLUMBING / SIGN I SFOKLER I 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)everettepsC,�veverettwigovI www everettwagov/perfnils <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: S W - PROPERTY TAX#: 00 43L50000 illono <br /> LEGAL <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(if Commercial); <br /> OWNER MAILING ADDRESS: SoH --7L' <br /> (Ily C—Y&"&A STAT E WA ZIP Cl 18 10 <br /> OWNER PHONE: `1 AS-, 416 - 00 SOWNER EMAIL: <br /> CONTRACTOR NAME 'J" <br /> CONTRACTOR ADDRESS: STREET a,0 <br /> CITY STATF WA- ZIP 1eA13 <br /> CONTRACTOR PHONE: 1CONTRACTOR EMAIL: I-C c t es c. <br /> CITY CONTRACTOR LICENSE#(RrQUIRED): C C C-5APYRS 1-16 Kig Fc;OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: [3 OWNER 5iCONTRACTOR 0 OTHER(Please Specify) .......... <br /> CONTACT NAME: CONTACT PHONE: -3 3 <br /> j gni CONTACT EMAIL: 1"C.C a o.A i x 5 <br /> BUILDING PE IT APPLICa <br /> Existing Use of Building: <br /> bdmmaJalm-rof Work: $ <br /> Proposed Use of Building: « Heat Source: OGaq OFIectric Elother <br /> Building Type: CSFB-Detached CSFR-Attached 0Duplex OMulti-Family-#of Units: ©Commercial ©Industrial <br /> Type of Project: ONew OAddition ORernodel ORepair OT.I. OSign OSprinkler DIDernolition Ochange of Use <br /> DESCRIPTION OF WORK: <br /> ?IZ1454 <br /> JASSOCIATED BUILDING PERMIT#(it applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn —Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C- Air Handling Units Heat Pump Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <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 Ot')er: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other <br /> Exhaust Fan Sink iService/Bar.Wopietc,) Other <br /> -L <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> lNumber of Heads <br /> ACKNOWLEDGEMENT I have reviewed Misapplication and confirm the information contained heteo 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 thotottory).Deviations must first be authorized in writing frorri the <br /> Building Official before,b;q',I'ng authorized un any <br /> ciicarnsterice,i am the owner or I amautrionzed by the owner of this property to perforin the work for which application is rnada, <br /> comply <br /> with <br /> and I cc State <br /> C ntr ors 18.27 RCW,,,d 296.200A WAC. <br /> City of Everett Officiat use only <br /> PERMI:T , <br /> 2- <br /> Owner/Authorized Agent Signature Dato (twviseci <br />