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PERMIT APPLICATION <br /> BUILDING I MECHANICAL!PLUMBING/SIGN /SPRINKLER! DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ) FAX 425-257-8857 lit)-tifieretttafisG gvere ,govtww <br /> w .everettwa.gov/permits <br /> (01ue or Black Ink-Oh*ase) - =PRROJE ,ate �;o 1IIIA. , 4 f <br /> N, x P <br /> PROJECT SITE ADDRESS (a a IPROPERTY TAX#: <br /> LEGALfor new construction: Short Platitotieivielart L t:No. (attach copy of long legal description) <br /> .... IONTA T INFORMA ION t;�*�- '.g ;;t, a, x.. • ,. ... <br /> OWNER NAME <br /> W"� _'Ce..1062) 1TENANT NAME(If Commercial)* <br /> OWNER MAILING ADDRESS STREETlitrlafC2 <br /> STATE ;O `".. ZIP g 2O3 <br /> OWNER PHONE. �_ - OWNER EMAIL <br /> CONTRACTOR NAME: COI . 11 . :1n: <br /> ,CONTRACTOR ADDRESS: STREETI1.4y J Q I <br /> T 1� - ZIP,,q 20 <br /> SATE <br /> CONTRACTOR PHONE: <br /> 2�� .. �+ �a� CONTRACTOR EMAII. •. f '{ �;� � a ; <br /> C+DNT Amit tC N REcuice):.... P mausli BS. Qt DyI <br /> c ..... <br /> PRIMARY CONTACT: 0 OWNER bcCONTRACTOR 0 OTHER(Please Specify).. <br /> CONTACT NAME: 05 <br /> CONTACT PHONE• �� ZG1)0010 <br /> Lia' CONTACT EMAILI�� <br /> .. . ' I UJLDIP PERM 1 " ICI , . ,_' <br /> Existing Use of Building: <br /> Contract Price of Work:$ � a *� _ t <br /> Proposed Use of Building: Heat Source: ❑Electric ❑Other <br /> Building Type APR-Detached ❑SFR-Attached QDt1pt'eat DMuitt amity-of Units, QCommercial Qindustrial <br /> Type of Project; ['New, DAddition QRemodel QReAair DTI i ign ClSpr-inkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ��}� - - on,,,.., rn.ctz¢_ <br /> SSOCIATEO BUILDING PERMIT#(if vip l lib e; <br /> MECHANICAL PER�APPLICAllatt,' <br /> �:, ,: PEA*BINGAPERMtTAPPUIOAT10N <br /> Typo of Project: _New _ Addn _Alteration _Repair Type of Project: New Addn Alteration _Repair <br /> #of <br /> w_....•�..frrzrvi�s—........ Vie.# _Y3xr lea, ' `�:' � fttt �� „' �Fixtures����#€�1"�ic; <br /> NC—Air HandJin Units Heal Pump Toilet Backflowpreventer finside Bldg) <br /> / Forced Forced Air Systems Unit Heater , Bathtub' .. Urinal <br /> t pGas Piping a Ier `lLavator1(Wash.Basin) `. -rainitin :Fountain <br /> Water Heater IkViit Shower oor Drain <br /> 1=1 <br /> Gas Fireplace` ' Shwa ° Kitchen Sink&Disposal �t rease Trap <br /> Gas Ranse - <br /> Dticilo E ....Dishwasher Rod Drains <br /> Clothes Dryer Hookups ()tat <br /> Clothes Washer ;, Medical Gas <br /> Range Hood ' <br /> - � - Water Heater Wither: �'` <br /> Exhaust Fan "' Sink(Service/Bar/Mopfetc:) Other: <br /> SPRINKLER/SUPPRESSION SY Y M <br /> 'Chemical or Water I " I <br /> No.of Heads ' .: <br /> ACKNOWLEDGEMENT:I 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 local law.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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ay of Everett Official Use Only <br /> ERMIT � \2, O?�-� <br /> _ <br /> vow fit~/;�`u�erlse StOnatura - tests '' � <br />