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Dec 09 15 10:38a p.2 <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL/PLUMBING f SIGN if SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(F)everetteps@everettwa.gov wwW.evelettwa.gav/permd5 <br /> PROJECT SITE ADDRESS: J� PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION . .:. : (I`t" )U. <br /> OWNER NAME: �b� t 0.rf hp >L�, [ Ll4j NAME(If Comme�eiaq: <br /> OWNER MAILING ADDRESS: 7 J ��/j-gal <br /> f/J� <br /> <,yrY S7ATE � "PF []I[1 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: i V <br /> CONTRACTOR ADDRESS: S--lank " `W-0/ 133 &hLol E vkm dl 1q— <br /> CRY l L S"'TE <br /> CONTRACTOR PHONE: ws-- 2 Yit"" lcoNTRAcToR EMAIL: �ao cvv g ,r <br /> CONTRACTOR LICENSE##REQUIRED)_ CITY OF EVERETT BUSINESS LICENSE#{REnutREn�: <br /> PRIMARY CONTACT: DOWNER 19 CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT N E: CONTACTPRONE: <br /> CONTACT EMAIL. <br /> BCJILDING7PERM!'F APP�:ICAT[ON:`..' . <br /> Fxstinq Use of Buikfi Contract Price of Work:$ ©a <br /> Proposed Use of Building: Heat Souroe: 10Gas OElectric Coater <br /> Bui[ding Type: OSFR-Detached [I-SFR-Attached DDuplex ❑Multi-Famil -*of Units: Xcommercial ❑Industrial <br /> T of Pr 'ecl: E]New §CAddition (]Remodel DR it ❑T.I. ❑Si n ❑S rinkler ❑Demolition CIChan a of Use <br /> DESCRIPTION OF WORK! wale f / /�V/ <br /> ASSOCIATED BUILDING PERMIT# if a livable: <br /> MECHANICAL- PERMIT:APPLiCAT101i_ P1 UI%8INd PEi5WT APPLICATIQN <br /> Type of Project _New Addn Alteration Repalr Type of Project: _New ____Addn Alteration Repair <br /> 0 of 13st of Fixtures N of List of Fixtures #of Gist of Fixtures *of List of Fixtures <br /> Fbrtures Fixtures Fixtwvs 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 ash Basin Drinking Fountain <br /> Water Heater Refr eration rShower Floor Drain <br /> Gas Fireplace Wood Stove IGtchen Sink&Disposal I Grease Trap <br /> Gas Ran a Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas <br /> Range Hood Water Heater Other_ <br /> Exhaust Fan Sink ServiceiBar/MO etc. Other_ <br /> SPRINKLL'RiSUPPRl�SSI N-SY tut. <br /> Number of Heads <br /> A CKNOWLEDGEMENT 1 have reviewed this application and oonrxm the kylarmation contained herein is true and correct Wb*done pursuant to this peen must comply with <br /> current federal,states.and focal taw.The granting OF permit ly authorizes approved work and no devfab6ns therafram_Dsviayons must firstbe authorized in writing from the <br /> Bur7ding CJfraial t:efcre being authorried underanymsta ce.f am the owner,or tam autlrorued ty the owner of this property to penbrm the work for utuch app6catfon is made <br /> and I comply with the Siate Conbzctars w1&27=an 296.2COA WAC- <br /> Cdy of Everett Orficia!Use Only <br /> PERMIT#_ <br /> O wne rlA uthoriy- d Agon t Sig Date (Revised 1011211015) <br />