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IT APPLICATION <br /> BUILDING I MECHANICALS PILUMBING I SIGN I SPRINKLER(DEMOLI40. :-- TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everauwa.govipermits <br /> (Shoe....oralack lnk:OIy Pleaser �pR ,. C'T_.fi'. �6 .........._._...._ __._..._.(Blue: <br /> . <br /> PROJECT SITE ADDRESS- r V� I - <br /> Q,, PROPERTY TAX#: <br /> LEGAL for new onstruction: Short Platlsubd€visvan <br /> __Lot No._ (attach copy of long legal description) <br /> CONTACT-INFORMATION-__ . -..- <br /> 7;NI~$�N/ttTE: <br /> TENA17;7ME(i#Commerciatj. atomor—gym <br /> OWNER MAILING ADDRESS: 3 I z.L:_r t.L 0 <br /> L€1, i-. <br /> __ <br /> OWNER PHONE: <br /> QS c3 OWNER EMAIL: <br /> CONTRACTOR NAME: $ <br /> CONTRACTOR ADDRESS: STREET 1 t+);' <br /> . - <br /> tC <br /> CITY ,t/te <br /> STATE >A f1— ZIP Cg20 <br /> ,CONTRACTOR PHONE: i2_5 2!3 . C.3:1156.0 CONTRACTOR EMAIL JAI I .. co 41 9 .Gowlt� NTRAGTO UCEASREE D):-{ 1}- jkSR'�—,CtF1C'ttERETT SJSfSS .CENSE#(KEUJtRE7)� <br /> 6674-g----- <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> �� ^ CONTACT PHONE: Com. 2. C D <br /> 5- <br /> �10 cJ CONTACT EMAIL: V <br /> _ : :;Burl ONStPERMWA i LOATt lam" "C4��., g <br /> Existin. Use of Builtfin4. <br /> Contract Price of Work:$ AO 0 <br /> roposed Use of Buildin*: <br /> Heat Source: te ❑Electric ❑Other <br /> Building T oe: ❑SFR-Detached ❑SFR-Attached t7 <br /> ._.._ - . <br /> up[ex ❑'�tuia-t-amiJ ��of nits: - _. <br /> Type of l°'r:aject. ONew ❑Addition ❑Commercial ❑Industrial <br /> DESCRIPTION OF WORK: C)f2smodel QRaair ❑� l 031 n QSprinkie ❑pemolifion C7Chan- a of Use <br /> ASSOCIATED BUILDING PERMIT#Of applicable l: <br /> MECHANICAC,PERMIT APPLICATION ' ` <br /> ' I'L'UMBINttipEE#!'4t1VAPR[IGATIOIV <br /> Type of Project: New , <br /> Addn Alteration Repair <br /> • #of Type of Project: New Addn Alteration Repair <br /> _.- l EbrfusesMI= #of <br /> 1.1111 7 tXf_ Fixtures 6F"tfixt er—_�_.. #of <br /> A/C—Air Handling Units Fixtures Lisf ofjrtures--. <br /> MEI Forced Air Handling <br /> Systems Heat Pump Toilet <br /> BackflMill Bathtub <br /> Urinal Preventer` Inside gid,) <br /> Gas Pi.jngallin Urinal <br /> Boiler Lavatory <br /> ry Wash Basin) Dunkin. Fountain <br /> montgamm <br /> MN Gas Fireplace —, Shower Floor Drain <br /> M`Gas Firepl 'Wood Stove Kitchen Sink&Ds anal <br /> MN GathRa D Sr Hooku s IMIIIIIIEIr Dishwasher GreaseoTrap <br /> tan.e Hood Other. Clothes Washer Roof Drains <br /> alallnallinmum Wafer Heater Medical Gas <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> FRtNKLEi'j`.a�UPP SS <br /> EM ;:' <br /> Chemical or Water <br /> No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application end confirm the Information contained herein is true and correct.Work done pursuant to this <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 wilting frcm the <br /> Building Official before being authorized under any circumstance.I am the owner,Cr!err,authorized bypermit must Comply with <br /> and I comply with the State Contractors Law 18.27 RCW and 2g6.2GOA WAC. <br /> the owner of this property to perform the work for which application is made, <br /> City of Everett Official Use Only <br /> .�L PER 1 <br /> ,Ow,er/Authorized Age Signature <br /> u 01 t©.22.•‘. `t �\O - S <br /> 9 Sign <br /> Data (Reviser'9/23/201N <br />