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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN/SPRINKLER i DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)ever teps@everett v grtrr I www.everettwa.govlpermits <br /> {Blue or-,,Blacki ik Ol l Follealse) fPROJL rSITE NItcrawAYIoN,„ : f <, <br /> PROJECT SITE ADDRESS: 1011 , O > „,t4e. JPROPERTY TAX# <br /> LEGAL for new construction: Short Plat/subdivision Lot No.' (attach copy of long legal description) <br /> OWNER NAME: rtrl<of) TENANT NAME(If Comrcl"al ,.._ <br /> OWNER,MAILING ADDRESS: STREET 1911 1) 1 ad< r <br /> yJ <br /> CITY er;G�tt STATE ., ZIP CitrA0� ... <br /> OWNER PHONE 42,e 252- styz OWNER:EMAIL:, <br /> CONTRACTOR NAME: f ll,C. <br /> CONTRACTOR ADDRESS: STREET <br /> CITY .. STATE � ZIP; i Jrr I <br /> CONTRACTOR PHONE: 1 2: 'a 0566 O . <br /> NTRACTOR EMAIL <br /> CONTRACTOR LICENSE EQU1I t 1- g1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) O(og, <br /> PRIMARY CONTACT: 0 OWN <br /> ER teCONTR.A.PTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: j,. 25 251' 055Z)�' CONTACT EMAIL Co: <br /> BUIM,DI 't PERMu 11 A ° t 'A "tosW, 73 ,w _ „. 11 <br /> Existing Use of Building: Contract.Price of Work:$ . ; t. © • <br /> Proposed Use of Building!, Heat Source: Nal ❑Electric ❑Other <br /> Building TZpe. =••.FR-tDetacbetl;, ❑SFR-Attached <br /> Dttplict,::,. Multi-Farnitof Units: ❑Commercial ❑industrial <br /> of Pt•ect: ❑New ❑Addition ❑Remodel t IR=®=ir DT I. D” •n : D :, ❑Demolition t W,a of Use <br /> DESCRIPTION OF WORK: t1Vn ^ , ,, C <br /> erf <br /> lnsbAA rl. c2 imcSe ' <br /> ASSOCIATED BUILDING PERMIT-# ifappllcable <br /> MECHANICAL PERMIT APPLiICA'TlON l' -4114A`-:5-!W`PLU BINGPERMIT APPLI A"EION ' <br /> Type of Project _New Addn Alteration Repair Type of Project: _New Addn Alteration _Repair <br /> #of <br /> List of Fixtures #of List of Fixtures • #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> Fo Forced Air Systems ndling Units 'Unit Heater Heat er q Bathtub M- Toilet Urinal w Preventer(Inside Bldg) <br /> J Gas Piping ,oiler Lavato Wash Basin, Drinking Fountain <br /> Water Heater ,w Refrigeration Shower Floor Drain <br /> I Gas Fireplace -Wood Stove <br /> P u,,... .: I'�Itc� 'Sf. �Diss®... .: <br /> Gas Range � v Grease Tra• <br /> 9 Ducting _ _,; Dishwasher Roof Drains. <br /> ' Clothes Dryer Hookups .' Other: \Ctothes_Washer Medical Gas <br /> Ran a Hood <br /> 9 , � Wafer Heater Other <br /> ,Exhaust Fan ,Sink(. rvloeii ar/Mapietc} Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water 1 [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 1 am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> (li..of Everett Official Use Only <br /> PERMIT <br /> J I 11'3.'I 7 1112' 6 02- <br /> 0 r AUtharrmd •S)$natu Da1e »\ 'at ed to. <br />