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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 I FAX 425-257-8857 i(E)everetteps@everettwa,gov I www.everettwa.gov/permits <br /> IOW*or Black InkOnly Please). PROJECT SiTE INFORMATION <br /> 'ROJECT SITE ADDRESS: 1/0 7 w"/J 4. fry' f ` 4 t) P !PROPERTY TAX#: (.:4()11,3%322M <br /> _EGAL for new construction: Short Plat/subdivision, Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> )WNER NAME; TENANT NAME(If Commercialy: <br /> )WNER MAILING ADDRESS .$TREET 07of-" E ,pkiv4- <br /> 'y✓ <br /> CITY eET W:4"' ZIP 26 <br /> )WNER PHONE 17125--$70 ....$[v y Z OWNER EMAIL:akkatnr? t '/. ; 40f/11 Ji q th <br /> :ONTRACTOR NAME CD+ ,� 1DN.E •,I ` /fit... p /NC* <br /> :ONTRACTOR ADDRESS: STREET 176►2'f /S" Aveolue, 4'4 0104 <br /> , <br /> CITY _._ :LA- STATE AiA- ZIP 9,foI1 <br /> :ONTRACTOR PHONE: � , CONTRACTOR EMAIL .v.•f#,i. Catefy � :£ t +F/' l"' x•CGVY1 <br /> :ONTRACTOR LICENSE#(REQUIRED): CO '0: CITY OF EVERETT BUSINESS LICENSE; • RE )t 0336'4 <br /> 'RIMARY CONTACT: 0 OWNER iiKONTRACTOR 0 OTHER(Please Specify) • <br /> ;ONTACT NAME.: ..ONTACT PHONE: 12,5-.' d/?.S'_O/// <br /> V'I 7 f��,. <br /> f1 :, � ">�4r ,,DDA) ° CONTACT.EMAIL: c fix � � <br /> BUILDING PERMIT APPLICATION <br /> Dasting Use of Building: _ �Contract Price of Work: f°" .•`2- •OD <br /> ?roposed Use of Buitdi Heat Source: ❑Gas ❑Electric <br /> 3uilding Type: FR Detached DSFR-Attached. ODuptex aMulti-Fan144 of Units, ❑commercial ❑industrial <br /> ,ype of Prpjec `:ONew i:Addition 0 Remodel tit CIT 1. D ttrt Ci prinkier. CIDemolition OChartge.,,of Use <br /> )ESCRIPTION OF WORK: `k <br /> '�/NJ�"{•/" " ' ! iCf'"1fr't% *' ' `t4? '•.: '� ' '�"r$ .� t.��! �1"`"" "' �'...- <br /> ASSOCIATED BUILDING PERMIT# if aprtte :: <br /> MECHANICAL PERMIT APPLCATION PLUMBING papilla LICA. <br /> New Addn <br /> 'ype <br /> of ) List ofw _ Addn #to eration -Repair # Type <br /> t: _ _ _Alteration Repair <br /> f <br /> e of Project _N List of Fixtures List Rp of project <br /> Fixtures of Fixtures res #°i List of Fixtures <br /> Fixtures Fixtures Fixtures ; Fixtures <br /> A/C M HandlingUnits ;' "Heat Pump Toilet ;Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 'Bathtub Urinal ' <br /> Gas Piping Boiler.._ Lavatory(Wash Basin) 'DrinkiFountain <br /> Water Heater Refrigeration shower , Floor D ain <br /> /Gas Fireplace Wood Stove Sitchen Sink&Disposal Grease Trap <br /> Gas Range 'Ducting Dishwasher Roof brains, F <br /> Clothes Dryer Hookups Other: Clothes Washer <br /> Medical Gas <br /> Range Hood Water Heater Other. <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLERfiliOh_SYSTEM <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 /> urrent federal,state.and local law.The granting of a permit only authonzes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> iuiIding Official before being authorized under any circumstance,J am the owner.or I am authorized by the owner of this property to perform the work for which application is made. <br /> nd I comply with the Stale Contractors Law 18:27 RCW and 296.200A WAC. <br /> of Everett Official Use Gritjr` <br /> P•fIT# <br /> o • <br /> 'moot AuthootelAstint•Signatke Date <br />