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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/PLUMBING /SIGN 1 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 (E)everetteps@everettwa.gov I wwweverettwa.govipermits <br /> (811,1*or Black Ink 9,111Y Please) FFIOJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: . .' , ' Mi PROPERTY TAX#: <br /> )LEGAL for new construction: Short Platisubdivtsion Lot Na. (attach copy of long legal description) <br /> CONTACT'INFORMATiON <br /> OWNER NAME: t, , - l7 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRE srass7 020 8: , <br /> `,.,.... ... CIT OPr a STATE ZIP P <br /> OWNER PHONE; 1042,41, 4.77$ OWNER EMAIL; <br /> CONTRACTOR NAME: CYttel HeJ4-it 116- <br /> CONTRACTOR ADDRESS: S''REET 11-1) 1 ' C1( <br /> - , ,ft. <br /> "`� STATE LIP <br /> CONTRACTOR PHONE: " sem.. ,4,50 0I "" t �het #r .coli <br /> � CONTRACTOR EMAIL: <br /> CON/TRACTOR LICENSE (REQUIRED):lei►tri tp-zd"r CiTY OF EVERETT BUSINESS LICENSE#( QUIP O): ttr " <br /> PRIMARY CONTACT: ❑OWNER y'i CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: - CONTACT PHONE: <br /> CONTACT EMAIL° d <br /> 44-0011,1***i Rmt r P IcAlio <br /> Existing Use of Building; Contract Price of Work:$ 0 <br /> Proposed Use of Buiidi Heat Source: OGas j lectrio ❑Other <br /> Building;,Type: it, FR-Detached OSFR-Attached ❑D *lexI Multi-Famil 4 of Units: ❑Commercial El industrial <br /> Typo of Pr« ❑New ❑Addition ❑Remodel D waalr ❑T,L O.$)ri IJ •rinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1 t I /Ica <br /> ASSOCIATED BUILDING PERMIT# .if a:`.iicattle <br /> MECHANICAL PE• Ir 'I; ,N PLUMBING PERMItAPPLIGATION <br /> Type of Protect: New _w Addn Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of <br /> List of Fixtures #°f #of <br /> Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures, Fixtures <br /> NC—Air Handling Units Heat Pump `Toilet 'Backflow Preventer Inside Bid. <br /> Forced Air Systems Unit Heater Bathtub rinal <br /> Gas Piping Boiler <br /> Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> das Ra en..a H Ductin. Dishwasher Roof Drains <br /> Gas R <br /> DryerClot <br /> Hookups Other: ' , ,Clothes Washer Medical Gas <br /> Range Hood <br /> _ Water Heater Other. <br /> Exhaust Fan <br /> Stnk(Service/Bar/Mop/etc) Other: <br /> tPRJNKLER t`SUPPRE SIEN SYSTEM <br /> Chemical or Water INo,of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Wong 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.t am the owner,or t am authorized by the owner of this properly to perform the work for which application is made, <br /> and i comply with the Slate Contractors Law 18,27 ROW and 296.200A WAD, <br /> Oily of Everett Official Use Only <br /> Q f PERMI ( /� 9 <br /> /Authorized Agar) •'t nature <br /> � gals {Revteadi47f <br />