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477- PERIT BUILDING / MECHANICAL I PLUMBING I SIGNn/SPRINKLER <br /> CITY OF EVERETT PERMIT SERVICES / DEMOLITION <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 1(E)everetteps@everettwa gov 1 www.everettwa.gov/permits <br /> Blue or Black Ink Only Please) PROJECT-SIT ANPORMATION. 0,'-1.-, <br /> PROJECT SITE ADDRESS; Ltkc."3 ` <br /> J IPROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivisior} <br /> Lot No.' (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME; pucAck. as-4w s <br /> cm TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET gcf3 a f rn LKS I y- ( r " <br /> CIV 'L zln L (�A9 <br /> STATE <br /> OWNER PHONE: iit: .5 34(e 6;03? <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: 14Q , n ,y-jC� <br /> CONTRACTOR ADDRESS: STREET 1L-. ' PJroci p, - ,oil <br /> CITY/Sr(...tAt <br /> STATE SJ1.I ZIP qg 2,0 <br /> CONTRACTOR PHONE: 42.s Z' 't 0550 1CONTRACTOR EMAIL' <br /> CONTRACTOR LJcIvs #(t���tatRED), - C����' @,. �- �`U�n .cG►1' <br /> CA 465,. -I4- -CITY OF-EVERET 8t1SINES$LICENSE#(ftEI:MIRED):106,C D <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 142.6 z5.7 0550 <br /> Toiato ti, <br /> JCONTACT EMAIL:dalla a q t'ttGC ,'Ti j .cow/ <br /> - BUILDING PERMIT APPLICATION '`.. <br /> Existin Use ofBuitdin Contract Price of Work:$ --" <br /> Proposed Use of Building: Heat Source: , Gas ❑Electric ❑Other <br /> Building Type: y FR-Detached ❑SFR-Attached ❑Duplex ❑Multl-Family-#ofaUnits: <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. °Sign ❑Sprinkler ❑Demolitio 00 ❑Change of Use <br /> mmercial ustrial <br /> DESCRIPTION OF WORK:pfie <br /> [ace <br /> ASSOCIATED BUILDING PERMIT#(if applicable):: <br /> MECHANICAL PERMIT APPLICATION <br /> Type of Protect: New Addn Alteration Repair Type of Project: New Addn Alteration _Repair <br /> Fixtures- t ftf.Flxture�_. #of LlstotFt rlurps__. #of #of <br /> Fixtures ' List"OfFlxtuFes ._ <br /> Fixtures <br /> ----List r FFixtures <br /> A/O—Air Handling Units Heat Pum Fixtures <br /> p Bat tubt ,Backflow Preventer(Inside Bldg) <br /> / Forced Air Systems Unit Heater Bathtub <br /> Gas Piping Boiler Urinal <br /> GWaternLavatory(Wash Basin) Drinking Fountain <br /> ,Refrigeration Shower Floor Drain <br /> Gas Fireplaces Wood Stove Kitchen Sink&Disposal Grease Tree <br /> Gas Range Ducting <br /> Clothes DryerClothes Washer Medical <br /> Other: Dishwasher Medi pram <br /> Range Hood calGas <br /> Exhaust Fan Water HeaterOther <br /> Sin (Service/Bar/Mop/etc.) Other; <br /> ' SPRINKLER I SUPPRESSION SYSTEM r <br /> jChemlcal or Water ) INo.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./am the owner,or I am authorized by the owner of this properly 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 g SignatureR <br /> ofEverett Official Use Only <br /> f PEW./ \r_I ( � <br /> Ow sr/Authorized A /222.-/7 \ (x q <br /> Date <br /> V\(Revised.912t7f6? <br />