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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 f(E)everetteps@everettwa.gov i www.everettwa,gov/permits <br /> zr <br /> (8I1410 or I3Iack lea Only Please) PROJEC'1 i E l$00 �t . <br /> PROJECT SITE ADDRESS: 72.2 1,2,j4 l1,-- PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT IN ORMAI ION <br /> > r <br /> OWNER NAME: VUr1.4, I""O TENANT NAME if Comiatercja, <br /> OWNER MAILING ADDRESS: nee 7 7 a22, pi! yam C• <br /> «. ...ZIP Ar 20 <br /> 40 OWNER'PHONE; 14,"2 " 1 4S.! OWNER EMAIL: <br /> CONTRACTOR X1 'ie It n6- <br /> , <br /> CONTRACTOR ADDRESS: STREET 14� t){ . <br /> ..nv �yJkwN ,��'� <br /> CONTRACTOR PHONE:�25 5 � CONTRACTOR EMAIL > i i Chet/Pleat; Cyn <br /> CONTRACTOR LICENSE#(REQUIRED)1 CAlrihtet.r 11.d i CITY OF EVERETT BUSINESS LICENSE#(RECIARED): 1(.00CitPRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONEa5,as9 0i561> <br /> CONTACT EMAIL: <br /> �i� Crk <br /> �rn <br /> e4.0,,,,,,,use of BUIIdin 2 Contract Price of Work' TA* 41'41.1111111111MIEINNIM <br /> Proposal Use of Building: Heat Source: P. as. DElectric...: ❑Other <br /> Building Type:' FR-Detached, , ❑SFR Attached Dbuptex DMulti-Famfty of Units; ❑Commercial ❑Industrial <br /> Type of Project:' DNew ❑Addition DRemodel 0Repalc ., DTI. 0Sign OSprinkler Demolition ❑Cha .:;of Use <br /> DESCRIPTION OF WORK. <br /> to e. 5 v rn.ac�e. <br /> ASSOCIATED BUILDING PERMIT#(iraPPHOKtbleyz <br /> MECHANICAL PERMIT L.ICATIOIN PI uMBIING,PERMIT APPLICATION <br /> Type of Project: New - Addn _Alteration .. Repair Type of Project: New _Adds Alteration _Repair <br /> #of - List of Fixtures #of _ — _ <br /> Fixtures Fixtures List of Fixtures #of i List of Fixtures #of List of Fixtures <br /> Fixtures; Fixtures <br /> NC—Air Handling Units ' Heat Pump Toilet Backflow Preventer(Inside Bldg) . <br /> 1 Forced Air Systems Unit Heater <br /> It Gas Piping Bathtub f Urinal <br /> P 9 Boiler Lavato (Wash Basin) Drinkin. Fountain <br /> Water Heater Refrigeration° Shower ioor Drain <br /> Gas Fireplace Wood Stove <br /> Itchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof`Drains <br /> Clothes Dryer Hookups ,.Other: <br /> y p � Clothes Washer Medical Gas <br /> Range Hood <br /> Nater Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER!aSNPP ESSION RYSIIIIIII <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:l have reviewed this application and confirm the information contained herein is true and correct.14;erte done pursuant to this permit must comply with <br /> current tedersl,state,and local Atm The grrtafing of,,0 pefry If only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being afatficrized under any cr5'cumstance.I am the owner,or!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 /> City of Everett Official Use Only <br /> �, I 24.17 <br /> PERM • ... �� C..� <br /> a <br /> 'Own0/Authorized Aleft ignatttre Date RefOktiti*23x=015) <br />