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13a jlellay 3 07' 1
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<br /> PERMIT APPLICATIO•
<br /> .1000111P,_ .
<br /> BUILDIN?MECHANICAL/ PLUMBING/SIGN.I.SPRINKLER 1 DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> '74111W" 3200 CEDAR STREET,EVERE,I I,WA 482+11
<br /> (P)42. -257-8810 I FAX 425-267-S857 1(E)everetteps@e,verettwa.gov i www.everetvw64.,L v/pai nuts
<br /> (Blue or Black Ink Only,Please) PROJECT SITE INFORMATION
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<br /> PROJECT SITE ADDRESS: 3(..., ,..) .1 ri-,,, 1 )-,,, ii,:k„,.. PROPERTY TAX it: C.,'1(,) ,) 4 ,L, c..c, ILC(,
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> CONTACT INFORMATION
<br /> OWNER NAME: 6 5 4--inn 3 r op c...c-31A'''''S TENANT NAME Of Commercial): ,C r-) I 11,..k Si}-.- ..e..-i
<br /> OWNER IVIAILING ADDRESS: STREET 3 6.,c .'..' S 11-t
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<br /> ctry s...y<,Vt.. Ajr STATS V.: i- 0. gi '2,0 I
<br /> OWNER PHONE: 5'L., 3..-5.1o.- 1.7 Vi OWNER EMAIL:
<br /> CONTRACTOR NAME:
<br /> CONTRACTORADDRESS: STREET
<br /> crrY ' STATE ZIP
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<br /> CO NTRAVrOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIREM: CITY OF.EVERETT BUSINESS LICENSE ti{F.EQIJIRED):
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<br /> PRIMARY CONTACT: al6VVNER 0 CONTRACTOR 0 OTHER(Please Specify)
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<br /> CONTACT NAME; CONTACT PHONE:
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<br /> 1....e.c._ V.,c:ls,:,,VC y.N.,, ,—‘3 CONTACT EMAIL: t....,e. c,ci.., c:.;,,,,,, ig 54 sc,..-1.. ,4,..,,,‘,,,, 1\,c,--,),-
<br /> BUILDING PERMIT APPLICATION
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<br /> Existing Use of Building; Contract Price of Work:$ 3...1'
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<br /> Proposed Use of Building: Heat tburce: 1:1Gas CIElectric DOthe!-
<br /> Building Type: DSFR-Detached CISFR-Attached 0 Duplex DMult-Family-#of Units: ODornmercial ID Industrial
<br /> Type of Project: 0 New DAddition URemodel. 0Repair DT,I. 0 Sign CISprinkier iKrnolition OChange of Use
<br /> DESCRIPTION OF WORK:
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<br /> fr'1 (X)Y1
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: New Addn Alteration Repalr Type of Project: New Addn _Alteration Repair
<br /> #of #of i i ,of m . ,,,,,.. #of #•of
<br /> :List of FixturesList of Fixtures List of Fixtures
<br /> Fixtures Fixtures ''s' '')441.'-'7 Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping -- Boiler Lavatory(V/ash Basin) Drinkirg 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 Other: Clothes Washeic Medic ii Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(ServiOe/Barifvlopietc.) Other:
<br /> SPRINKLER/SUPPRESSION SYSTEM _,
<br /> Number of Heads ..
<br /> ACKNOWLEDGEMENT'I have reviewed this application and confirm the information contained herein is true and correct Work done pursuant to tis permit must comply with
<br /> current federal,state,and local law.The granting of a permit only authorizes approved work arid 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 bf this,property to perform the work for kith/Oh application Is made:
<br /> and I comply with the State Contractors Law 18,27 ROW and 296 200A WAC.
<br /> City of Everett Official Use Only
<br /> it" 1 .. ..31 .1•6, PERMIT#
<br /> ,.. D 1 60-7-o 08
<br /> Owner/Authorized Agent Signature Date (ReiriSed 5/20/2018)
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