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PERMIT APPLICATI <br /> BUILDIPI MECHANICAL I PLUMBING I SIGP7FSPRiNKLER.1 DEMOLITION <br /> CITY OF EVERE-i'PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98209 <br /> (P)425-267-8810 l FAX 425-257-8857 l(E)everetteps@everettwa.gov www.everettwa.gov/permits <br /> ffPROJECT <br /> E ADDRESS: PROPERTY TAXconstruction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> _,... .•.�®I�i�'�,c�`URZIr®R41pi,A`It`g®lE4 . . .:•. - , .,•- ':.: <br /> OWNER NAME• Old <br /> 4Zd, TEfJANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: =(.2a[ AA- <br /> CONTRACTOR ADDRESS: STREET ?,A ZC) <br /> CITY STATE WA ZIP <br /> CONTRACTOR PHONE: ( ZS '7-52- 5 Lt- 1CONTRAGTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR El OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( j� `0-7Z;Z— <br /> Lir( CONTACT EMAIL; <br /> ;.13UI0INQ PRItMitA.tbPATIO. <br /> A . <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: VGas ElElecfric ElOther <br /> Building Type: EISFR-Detached OSFRAttached ❑Duplex ❑Multi-Family-#of Units: ommercial ❑Industrial <br /> Type of Project: ❑New DAddifion ORemodel ❑Repair EIT.I. []Sign []Sprinkler ❑Demolition @(Change of Use <br /> DESCRIPTION OF WORK: Wes EXIT <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 4AN_9���:( 1l�IN�i �� ?l�i� ,I d® !1' PF��Afil�l(1 � ?L6A <br /> Type of Project: Now Addn Alteration Repair Type of Project: _New Addn Alteration _,Repair <br /> °f List of.Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A!C—Air Handling Units JHeatPump ITollet I Backflow Preventer(Inside Bldg) <br /> Forced Air Systems I Unit Heater Bathtub Urinal <br /> Gas Piping lBoiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration IShower Floor Drain <br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting JDfshwasher Roof Drains <br /> Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan JSlnk(Service/Bar/Mop/eta) Other: <br /> ...a:=.-•��l�y�l�)�I�fP�../.��i�P�[����®[t€1.�1'i���`I�.E�1.. . - <br /> Number of Heads <br /> ACKNOWLEDGEMENT'/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 locallaw.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!am authorized by the owner of this property to perform the work for which application is mads, <br /> and i comply4ifzedggent <br /> Contractors La 8.27 RCI and 296 200A WAC. <br /> City of Everett Oficial Use Only <br /> ��✓ � PERMIT ��A <br /> )wner/AuthSigna Dale (Revised 5/20/2096) <br />