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PERMIT APPLICATIOilk <br /> N <br /> BUILDING—ECHANICAL/PLUMBING/SIGN / INKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ra 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ): FAX 425-257-8857 1(E)everetteps@everettwa.gov i www.everettwa.govfpermits <br /> (Blue or.Black Ink Only PII001004 Plit0JECT';SITE INFORMATION <br /> PROJECT SITE ADDRESS: 4124 4 it 4PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: illyti "41 telettee TENANT NAME(If Commercial):. <br /> OWNER MAILING ADDRESS: STREET <br /> cnv STATE4 soft <br /> OWNER PHONE: (I T a'4) OWNER EMAIL: <br /> CONTRACTOR NAME: t^ <br /> CONTRACTOR ADDRESS: STREET <br /> CITYe,A)erelr ,_ ,` ;: STATE <br /> CONTRACTOR PHONE: it,. %III.. 0 d#• CONTRACTOR EMAIL: • �-dOckYtklecetift + colli <br /> CONTRACTOR LICENSE (REQVl EM;C Nita" lids CITY OF EVERETT BUSINESS LICENSE#(REQUJRED) CfCCkS <br /> PRIMARY CONTACT: 0 OWNER >'4.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTNApM7E� CONTACT PHONE: 4 <br /> ffEMAIL. <br /> 5 , <br /> �/t V►�1. f T' I COACT EMAIL:1�, a'{"h c'Tt 'fO <br /> „BUILD NG ERMIT AP1'L 1 ATI N <br /> Existing Use of Building: Contract Price of Work: <br /> NsfProposed Use of Building: Heat Source: es ❑Electric .❑Other <br /> Building Type' FR-Datacsi elf OSFR-Attached 131Duplex ❑Multi-Fargil of Units: ❑Commercial ❑Industrial <br /> Type of Pr Ject.`; ONew OAddition ❑Remodel ❑Repair OT L aSign CiSerinktO ❑Demolition D hange-of Use <br /> ( CRIPTiON OF WORK: <br /> 'hun c6 ?(Fe-Pcorn‘ex(Sh,a1nac.t-to EZ.an9-e $$Q , dR eF� <br /> ASSOCIATED BUILDING PERMIT# if a*dl cable <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration _Repair Type of Project New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures , Fixtures <br /> —Air Handling Units Heat Pump Tdilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub -Urinal <br /> Gas Piping —Boiler Lavatory(Wash Basin), Drinking Fountain <br /> Water Heater Refrigeration _Shower Floor Drain <br /> Gas Fireplace Wood Stove " Kitchen Sink&DisposalGrease Trap <br /> Gas Range ' Ducting Dishwasher Roof Drains' <br /> ,Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: 4 <br /> Exhaust Fan - Sink(Service/Bar/Mop/etc:)+ Other: <br /> SPRINKLER i SUPPRESSION SYSTEM <br /> [Chemical or Water JNo.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 I 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 /> PERMIT <br /> i d .. CD <br /> 464.11.444 y <br /> Qwrieriltcattaisrieed Agent.t8igtattr Date Reviead /el <br />