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i <br /> PERMIT APPLICATION <br /> BUILDING/'MECHANICAL l PLUMBING I SIGN I SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (PI 425-257-8810 j FAX 425-257-8857 1(E)everetteps@everetNo.gov► wwweveretNo.gov/p+ermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: R—t 1 Lf -- F°$t't+'Z, 5�7PROPERTY TAX#: 00 C C L 0 <br /> LEGAL for new construction: Short Plattsubdi vision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: �� ,� � TENANT NAME(it Commercial): <br /> OWNER MAILING ADDRESS: STREET 1&"4 <br /> $u. <br /> City STATE ZIP <br /> OWNER PHONE: a - OWNER EMAIL: <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: STREET <br /> my ,./iw. STATE ZP <br /> CONTRACTOR PHONE: COIiIMCTOR EMAIL-TY'kp C <br /> CONTRACTOR LICENSE#(REQUIRED): op CITY OF EVERETT BUSINESS LICENSE A( RED1Vk1QQt A. <br /> PRIMARY CONTACT: ❑OWNER WCONTRACTOR Q OTHER(Please Specify) <br /> CONTACT NAME: )I CX-MIS C)i-2_ CONTACT PHONE: z4t),5 1 7b -45 - <br /> �'t ( {. CONTACT EMAIL: jcl <br /> Ira <br /> BUILDING PERMIT APPLICATION <br /> E)dsting Use of Build Contract Price of Work:i .� 7 7, <br /> Proposed Use of Building: Heat Source: QGas ❑Electric 00ther <br /> Building Type: OSFR-Detached EISFR-Attached Oclupiex ❑Multi-Famil -#of Units: ClGommerciat ❑lndustriFal <br /> Typeol'Project ©New ❑Additi+on ORemodel 011epstir [3T.l. DSi n OSprinkler ❑Demolition ElChangeolUse, <br /> DESCRIPTION OF WORK: <br /> V t <br /> ASSOCIATED BUILDING PETIT# if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type' P jest _New _ Aridn Alteration _Repair Type of Project; _New Attdn llttera#lcwr _Repair <br /> of f List of FfaRwas #of List of Fixtures #o/ Lfat of Fid #of List of F&Um" <br /> Fixtures Fixtures fixtures Fixtures <br /> A1C—Air HandlingUnits Heat Pump Toilet Backflow Preventer(inside B ) <br /> F Air Systems Unit Heater Bathtub Urinal <br /> f Gas Piping Boiler L.avat ash Basin DrinkingFountain <br /> Flom Water Heater Refrigeration Shower FloDram <br /> Gas Fireplace Wood Stave Kitchen Sink&Disposal Grease Trap <br /> Gas Range Duetin Dishwasher Roof Drains <br /> Clothes r Hookas Other. Clothes Washer MedcalGas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink Servkxd8arlMa etc. Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACl(NOWLE?GEMFNT:t have reviewed this applrcatton and confirm the infom+etlon contained toerein is tree and correct. Work dorie pursua4 to fln peak must oarr0e wdh <br /> current federal,state,acrd tical taw. The grantkV of a penrhf only auth+ohms approved work and no devistions therefrom.Deviabom must first be sWxx zed in wrAng hom the <br /> Bung Ofhclal Wore being atithonzed under any amumstartoe-l am the owner,or t am avthonzed by the owner of this property to peritxm the wor*for wthidt aplabcakn is area, <br /> and t coir4:ily with State Contractors Law 18,27 RCW and 296,2"WAG. <br /> j coy--of Ewaratt La l Use Cloy <br /> _ <br /> ! � , PE MI llel\2 2 <br /> OwnerlAuthorized Agent Signature Date (Revised 912"016) <br />