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II'' PERMIT APPLICATION IIII'I <br /> BUILDtNG I19fECHA <br /> , ! NICAL/ PLUMBING /SIGN /�NKLER/ DEMOLITION <br /> CITY OF EVERETT PERiv11T SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P}425-257-8810 � FAX 425-257-8857 �(E)everetteps@evereriwa.gov� www.ev�rettwa.gov/permits <br /> _ _. _ _ _ _ _ <br /> _ __ __ _ <br /> , _ __ _ _ _ <br /> ,(Blue or Black Ink Only Piease} PROJECT SITE INFORMATION " <br /> _ _ _ __ _ _ <br /> PROJECT SITE ADDRESS: NQ(p ,�� rQ�',sS� �{IE� . ., W'i� ,._ ZO PROPERTY TAX#: OO ; OOOOO 57/ <br /> _ _ __ _ _ <br /> LEGAL for new construction: Shart Plattsubdivasd4� . Lctt No.. (attach copy of lang legal description) <br /> CONTACT 1NFORMATION . <br /> OWNER NAME: � 'Q,__ W�e THNANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srReer � e d'� ! <br /> cirr y��' ._ . srnT� {JV�QI ziP l VZd <br /> - <br /> OWNER PHONE: '1 Z5.-MI'I — ���f+t;EMAIL:dWQA�Ps 1� qlY .. � . <br /> CONTRACTOR NAME: CD�QI�J /Q (ST�N� Rc�F/..NG 1 NC., _ <br /> _ <br /> _ <br /> _ <br /> GONTRACTOR ADORESS: srReeT )'�]ri2�/ /J"� d <br /> _:. � �r�� Ol�l _ _ <br /> c�rv cLSLJ�. �..�- _ s'rare �� zia 7��!�: <br /> CONTRACTOR PHONE: .��'— �,S'_ CONTRACTOR EMAIL: CQ/Q�V R�F�N�.,C�� <br /> CONTRACTOR L,ICENSE..#(REQUIRED) ... '�/Q/�/�, D,Z,�,L'/}�J CITY OF EVERETT BUSINESS LIGENSE#(REQUIRED): O33SG <br /> PRIMARY CONTACT: ❑OWNER C�'G�ONTRACTOR ❑OTHER{Please Specify) <br /> . _. .: <br /> GONTACT NAMEs CONTACT PHONE � Yz�--../�85-D/// <br /> _ _ <br /> cSAQA� GD+PN/5�, o���C� �9rv�4GF'�2 CONTACT EMAlL:��14 CAIQNER.S�TGYV�72Cl7F�NG.c,om <br /> : �UILD�.NG PERMIT APPLICATION <br /> _ _ <br /> Existin Use of Building: SINC�L� Contract Price of Work:$a, . -. . 0'Ca <br /> ... .,.,.. __ _ _. __,, <br /> Proposed Use of Buildin t `� Heat Source: ❑Gas ❑Electric ❑Other <br /> _ _ _ <br /> $uildin _T e: CaS�R-Detached ❑SFR-Attached ❑Du lex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> _ _ <br /> T. of l�ro°�t: ❑New ❑Addition �Remodel L��ir C7T 1 ���' tt. L7, �i�►kler ❑QemQ.libon D�F�art e of Use ' <br /> DESCRIPTION OF WORK; _ _ <br /> �-►riov�_�'►'Y.�O�,i�t 6v�- '�".�(Q(sL.W j C,6�rvYv(�4'i-�i 971. �'C!�'f bd'�'1°r.'�+b19'�E�— <br /> ASSOCIATED BUILDING.PERMIT# if apPlicable): <br /> ;_ MECHANlCAL PERINrT APPLICATION PLUMB�NG PERNIIT APPLICATION <br /> ype of Project: _New _ Addn ,,,_Alteration _,,Repair Type oi ProJect: _New _Addn _Alteratlon _Repair ' <br /> #of #bf. _ #of #of <br /> t�st of Fixtures Lest af Flxtures List of�lx2ures List of Fixtures <br /> Fixtares : F/xtures Eixtnres_ Fixtures . _ <br /> iAlC-Air Handlin Unifs- Heat`Pum 7oilet '."': a.akflow Preventer lnside;Bid <br /> Forced Air S stems ' _ Unit Heater__ 8athtub �Jrinal <br /> Gas Pi in eoiler _; �.avato Wash Basin __, Drir�kin Fountain _ <br /> Water Heater Refri eration ; Shower _ Floor Qrain <br /> ; Gas�i�ep���e. Wood Stove Kitchen Sink 8 Dis osal Grease Trap_ <br /> . __ �._ <br /> 'Gas Ran e ' buctir� ' Dishwasher Roof Drains <br /> Giothes D er"Nooku s `. ' bther: '�lothes Washer Medical Gas <br /> _ _ <br /> Ran e Hood _ `'WaEer Reater ' :Other: <br /> Exhaust Fan ": ;.5ink erviae/Bar/Mo letc. Ofher:' __. <br /> , <br /> SPRINKLER 1 SUPPRESSION SYSTEM ; <br /> -.: <br /> �iumber of�lea s ; _ <br /> _ _. _ _ <br /> _ _ <br /> ACKNOWLEDGEMENT.•1 have reviewed this application and confrmt the information contained herein is t�ue and correct,:Work done pursuant to ihis permil must compiy with <br /> current federal,state,and locaf law.The granting of a permit only authorizes approved work and no deviations therehom.Deviations musl frst be authorixed in wnting from fhe <br /> 8uilding O�(iciat before being authaized under any circumstance:.f am the owner,or t am aufhorized by the owner of lhis property to perform the work for which applicalion is made, <br /> and 1 comply with the State Contractois Law J8.27 RCW and 296:200A WAC. <br /> Ciry of Everett O�cral Use Only <br /> o .. <br /> �.��_ <br /> !o a� �o�� PE�#��o � (� �- Q�j� <br /> Ci+N�ieY Ay4hofit�etl`Agent Signature Date , (,R�vi�atl�£:�:At6� '" : <br />