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III <br /> PEFRMIT APPLICATIIC3>J <br /> " BUILDING 1 MECHANICAL 1 PLU11�13 NG t BII IV l SPRINKLER DEMOLITION <br /> CITY OF EVERE i i PERMIT SERVICES <br /> a 8200 CEDAR STREET,EVERETT,WA 98201 <br /> - (P)425487-88't0 i FAX.425.257-8857 I(E)everetfeps everefiwa,gov] www.everettwa govtpermits <br /> y ... <br /> PROJECT SITE ADDRESS:GOO- 16441 iase PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No., (attach copy of Tong legal desctiptibrt) <br /> OWNER,NAME_', L 1 U L fl TENANT NAME(If Commercial):.. <br /> OWNER MAILING ADDRESS: sraccr 5—C)c?.`f° / IL) <br /> CiTVV. - k J'/ STATE l >' <br /> OWNER PHONE , 6t) 1q ozi� . OWNER EMAIL: <br /> CONTRACTOR NAME: ! 1 f 'eG n -- '/ <br /> ""l <br /> CONTRACTOR ADDRESS: STREET —7 d 7 fritifre., 11 <br /> CITY T$1fi_'4f` i /tit "STATE ZIP e w <br /> CONTRACTOR PHONE: 40.5_ W(V. 3CONTRA TOR EMAIL: erasiv <br /> CONTRACTOR LICENSE#(REQUIRED): r )9T g' L ,Tta CITY OF EVERETT BUSINESS LICENSE#(REOUIRE[t) , <br /> PRIMARY CONTACT: '[ OWNER icar,ONTRACTOR 0 OTHER(Please Specify) , <br /> CONTACT • CONTACT PHONE: ~- <br /> 1 41 as <br /> ` CONTACT EMAI <br /> ,. ,, , .. _ .c , . .60.# rO OAlrl°N.MV.* c�,` .may -::::''.,t;^;, <br /> Existing Use of Building: Contract Price of Workil • <br /> Proposed Use of Building: Heat Source: etas COElectric Cipther _,_ <br /> Builditg Type: FR-Detache CISFR-Attached °Duplex ClMultiFamily4 of Units: r 0Cornmercial ®industrial_ <br /> Type of Project: CINew °Addition C4Remodel q�rRepair }CIT.': CiSfgn QSprinlcier' _©Demolition RCI aage of Use <br /> DESCRIPTION OF WORK: t l 1" f 11 t('"1 C 4. r"-i 1 .rr; <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 1 1. i" r•4 elf's 1 .,., !l lil6i1 , .a .Pi7 i. ..:3 ,C .,141°'. C' � .***** iO �, <br /> Type of Project:, New Adan _,,,Alteration „_ Repair Type of Project New Addn _,... Alteration _Repair <br /> of •List of F ittur.es #of List of Fbtturei of List of Fixtures #of List of Fixtures <br /> Fixtures res F7xtures Fie:tires <br /> A!C - JrAHandling Units .,'Unit <br /> Pum Toilet Backtiow;Preventer(Inside Bldg) <br /> Forced Air Systems .. _ Unit Heater Bathtub Urinal. . <br /> Gas Piping Sailer _ Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove lichen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Oreille. <br /> Clothes Dryer Hookups - Other: Clothes Washer Medical Gas <br /> Range.Hood Water Heater Other <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> g <br /> jChernical or Water No .of Heads <br /> ACKNOWLEDOEMMENT:!:have revieMted tills application and confirm the intermation contained herein is two and correct:Work done pursuant to this permit must comply with <br /> current federal,state,and local law.The granting orf a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writing from the. <br /> Building Official before being authoriged under any circumstance.lam the owner,ort am authorized by the owner of this property to perlenn the work kr which application Is made. . <br /> and i commy with the State CnntractorsLew 98.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> _; _1 Pl= at Vt® l 65-. <br /> 40 mvi <br /> OwneriAuth• zed Agent Signature Date, (Revised 8123 1e) <br />