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PERMIT APPLICATION <br /> BUILDING/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 1(E)avarettapsgave,rettwa.goyl wvat.cavaratrata.gov/permits <br /> Moe ctilinack-InkOniy Please) 01i0)4110141**P.OrtrOtAtiON4olal44 <br /> PROJECT SITE ADDRESS: 2101 14. Lo nA,. pRopERT,TAX#: <br /> LEGL„for new construction: Short Plat/subdivision Lot No, (attach copy of long legal description) <br /> WrAv:*"-4 <br /> OWNER NAME: eAr rrat. TENANT NAME.Of Conta,HIP:a4: <br /> OWNER MAILING ADDRESS: STREET 2k 4 Lb <br /> STATE <br /> 11' <br /> ZIP <br /> 1,4) <br /> OWNER PHONE: is S70 Lf4 'OWNER EMAIL' <br /> CONTRACTOR NAME: tl I <br /> CONTRACTOR ADDRESS STREET JLtDroaciloociA,i il. <br /> CITY giber4 ,1t. STATE zcszotA4 <br /> CONTRACTOR PHONE: cbq. iv 60 CONTRACTOR ElitAlt.,44,„, <br /> CONXRACTORAAGENSEAREQUIRED)tttYV ' ort orEVERETTBUSiNESSMENIMAREQUOMP' <br /> PRIMARY CONTACT: DOWNER teCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE 2.5 <br /> -1)eb)o Led CONTACT EMAIL ' elfAtie CO <br /> BUILDINWPERIVIrt AP ti! TAO 17, " <br /> Existing Use of Building: <br /> ProPOSed Use of Buildim <br /> Meat Source: .0$1Gas 0 Electric <br /> - <br /> Buildin!T e FR-Detached EISFR-Attached 0Multi-Fami 4 of Units: CICommercial Olndustrial <br /> Type of Project ONew OAddition IZIRemodel Clftpak Dr I 0Sign °Sprit** ODentolition Clatande of Use <br /> bESCRIPT1ON OF WORK: R <br /> ASSOCIATED BUILDING PERMIT#(IfoptatioabJe.p <br /> MECHANNIAL,peomit.-AppLit-ATtoti T otomEuticirinottviivAppciovrioN <br /> Toe of Project: _New Addn Alteration Repair Type of Project New Addn Alteration _Repair <br /> of <br /> Fixtures <br /> —Air Handling Units :Heat Pump - diet Backflow Preventer(Inside Bidg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping ,Z041141 ( Asti Basin) brinking Fountain <br /> ta <br /> Floor Drain <br /> Gas Fireplace Wood atevq. 11601,Ski&OS qsal <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Met: Clothes Washer Medical Gas <br /> Range Hood Vater Heater <br /> Exhaijst Fan Sink(Service/BarlMop/etc other <br /> SPRINKLER tsUppREsemoN SYSTEM <br /> <or, <br /> 'Chemical or Water I 'No.of I-leads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true end 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 /> end I comply with the Stale Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> FERpf <br /> 11\(2)•—• <br /> U /2-12-1/ <br /> 0 Outfit)ixed Signature' Date (Rovised 914/20481 <br />