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0.111111PPERMIT APPLICATION <br /> BUILDING / MECHANICAL I PLUMBING /SIGN /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 v;I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please PROJECT SITE IN .*MATION" <br /> n r <br /> PROJECT SITE ADDRESS: 3(o2E. $)/ f I . . PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> ON <br /> OWNER NAME: s0tr. 1ki` a i#i' t TENANT NAME(If Commercial.: <br /> OWNER MAILING ADDRESS: STREET:23CD420 <br /> arr STATE ZIP <br /> OWNER PHONE. .. ,..rt A. OWNER EMAIL: : <br /> �'as .,,„„74 -r. at tr -"" ,RA " *�' & A':'; ' �AAA <br /> .. <br /> 1 <br /> CONTRACTOR NAME: k e 4n <br /> CONTRACTOR ADDRESS; STREET 141'6 1 #1 1 � <br /> CITY ei,Y r" STATE ZIP 1 <br /> 'CONTRACTOR PHONE: ► 0). 0119,CONTR`t TOR EMAIL: t ", }® t awl il`+'�+� " <br /> � <br /> CONTRACTOR LICENSE#REQUIRED):um -fCL ry i 1Zd r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): i te� <br /> PRIMARY CONTACT: 0 OWNER tCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: -,>as asci <br /> CONTACT EMAIL t ebb l Q Cr'l ''t. trig to fM <br /> Existhi Use of Buildin <br /> i' Contract Price of Work: +#. <br /> Proposed Use of Building:` Heat Source: .1 Gas ❑Electric ❑Other <br /> Building Type: LSFR-Detached OSFR-Attached C 9u lex ❑Multi-Partillyt€of Units DCommerclal ❑Industrial <br /> Type of Project>. ONew ❑Addition ❑Remodel Cinema* DTI. ❑Sign ;©Sprinklet ODemolition I t Range of Use <br /> DESCRIPTION OF WORK, <br /> Lko Gall,ofl (tas, po-ir Wa kf" heRep c -- <br /> ASSOCIATED BUILDING PERMIT#(If-a Iicable), <br /> MECHANICAL PERMIT APPLICATION PLNIVISINE PERMIT 0,1110119N <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of <br /> Fixtures List of Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures ; <br /> A/C—Air Handling Units Heat Pum• p Toilet 'Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping —Boiler Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stovechen Sink&Disposal 'Grease Trap <br /> Gas Range Ducting 'Dishwasher Roof Drains ` <br /> Clothes Dryer Hookups . Other: ' Clothes Washer Medical Gas , <br /> Range Hood , Water Heater Other: <br /> Exhaust Fan Sink aerviceiSar/Mo«fete. Other: <br /> SPRINKLER I SUPPRESSION SYSTEMf <br /> 'Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm the information contained herein is true end correct.Wo,*rdone 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 tram the <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 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 of Everett Official Use Only <br /> .; PERMIT# <br /> °s 004 - + 6/31(11 <br /> a.�..... ... <br /> 't:fwne/Authorized'Agen 'Igrtature ❑x . . (Revised 9I2 Oil: <br />