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0141',--A
<br /> PERMIT APPLICATIO
<br /> BUILDIMECHANICAL/PLUMBING /SI e---11•---PRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SER It,
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 l- FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> q , PROJECT SITE INFORMATION ,
<br /> PIr(QJ(� sr o t D Rks L r,),,,..4.4.. tri pt. 9 vZ,( PROPERTY TAX#: 00413? © 31 (0 3 I d d
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ,_ CONTACT INFORMATION: ;.._
<br /> OWNER NAME: t1.,ti _Z jti TENANT NAME(If Commercial):
<br /> J
<br /> OWNER MAILING ADDRESS: STREET 1 6 O L C ` 17 AJ-c-
<br /> CITY
<br /> CITY 1_,/G 1J/e— 4— r/ t STATE 04 ZIP 2-dOWNER PHONE: �i ,(o Gs-6" ZZ- OWNER EMAIL: 3L . e fAc.f ke.4'5+' 4 atV. --" -'-
<br /> CONTRACTOR NAME: I x J r- tO
<br /> Z^�� ^J�Z Co.,S-i- `
<br /> CONTRACTOR ADDRESS: STREET C_ 6 rd 4."G'-' l 5,..-k tat is--z0
<br /> CIN F vC.,..-c-4-4- STATE `") A ZIP 9
<br /> CONTRACTOR PHONE: 10(e 41 (0( 1 CO e( CONTRACTOR EMAIL: /4 ter'/L e(Z)Cur-(\6, i C d
<br /> CONTRACTOR LICENSE#(REQUIRED): A)(,0 l\ -- C) Z- C) L. 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Qg`/ysJ
<br /> PRIMARY CONTACT: KJ OWNER El CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAMEE:i CONTACT PHONE: 2c)e Co 5�y -Z Z_
<br /> V V�1.'" A f,d1 CONTACT EMAIL: 0,,, ° A4,r 44 5+,...,_,_.4-6_,),C;t,`.
<br /> BUILDING PERMIt0.01-I00IO4
<br /> Existing Use of Building: � ?....3 k,c �•r-it7 aeS+l.•-d‹._ Contract Price of Work:$ 200,do D f
<br /> Proposed Use of Building: 5r Heat Source: VrGas ❑Electric 0Other
<br /> Building Type: XSFR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition L Remodel ❑Repair DT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: 6,,, 1c�v..,.F. og. to�54..,..,....,.+- trt...-4.LC, ,%-S.)-- 4-, - e,....1 ecr.v,c.. +>Pia,F
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHAN1CAL'PERMITAPPLICATION '. ` .. , PLUMBING POWit 40,PLICATION,.„ . ,:,
<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 /> A/C-Air Handling Units Heat.Pump ( / ( Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater f Bathtub Urinal
<br /> Gas Piping Boiler lig! Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration I I I Shower Floor Drain
<br /> Gas Fireplace Wood Stove ( Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting I Dishwasher Roof Drains
<br /> (�( Clothes Dryer Hookups Other: II Clothes Washer Medical Gas
<br /> I Range Hood I Water Heater Other:
<br /> rn((I Exhaust Fan )/ Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/.S,UPPRESSLON SYSTEM;.,: ;,
<br /> !Number of Heads
<br /> ACKNOWLEDGEMENT:!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.lam the owner,or l am authorized by the owner of this property to perform the work for which application is made,
<br /> and/comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> '
<br /> (r/ 6 PERMIT# G i (G0(-1 - li I J _ ,
<br /> ^t
<br /> Owner/Authorized Agen Signature Date (Revised 90/92/2095) ( \ "1 )
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