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BUILDING / MECHANICAL!PLUMBING CSIGNN <br /> I SPRINKLER!DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> tP)425-257-8810 I FAX 425-257-8857 ICE) <br /> ( )everettepsgQevarettvva.gov I www.everettwa,govfpermits <br /> (Blue or`Black'Ink Only Please) PFtt3J�C'!`-51'I'�.IN��:itlVt�N <br /> PROJECT SITE ADDRESS: 4 UL,1's t tent <br /> rI <br /> LEGAL for new construction: Short Plabsubdivis€on r PROPERTY TAX#: <br /> Lot No.' (attach copy of long legal description) <br /> OWNER NAME: , , i'.�lf�!� . rtir COI TA T INFO MATION <br /> .A . UJJNANT NAME Of Comrrterctat), <br /> OWNER MAILING ADDRESS: STREET ;; , l Psi <br /> d Ave. <br /> CITY VAIIC•0 Ui ' ' e • <br /> ✓ STATE <br /> OWNER PHONE. +4 , ► 1 ZIP <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: / pCr --- <br /> CONTRACTOR ADDRESS: STREET i 30- t". 0t,.CLIOi <br /> CITY ,eft r_ , <br /> CONTRACTOR PHONE: ��yy STATE 4,,. zla it : 0 1 <br /> , D 0 CONTRACTOR EMAIL' AI 4 , 1► • <br /> CONTRACTOR�tCENSE-#(RFQt11RFt"3): F.015R14--- AA ' - � !�� .CO <br /> CITY OFi~'VERETr eU$NESS LICENSE'lf(REQttIRED)' '..O(p' <br /> PRIMARY CONTACT: 0 OWNER [CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: +� <br /> CONTACT PHONE: Lt-2.6 2.59 0 G <br /> CONTACT EMAIL: pt +1G <br /> e c,„,,, a] .Cr:011 <br /> BUILDING PERMIT APPLICATION' _ z <br /> iWxistlrr Use of$ui€ding; <br /> Contract Price of Work:$� <br /> Proposed Use of>3ulidln;; .�. „ �„_ <br /> Buifdin$ T pe: 1,1 FR-Detached ❑SFR-Attached Heat Source: .1'Gas QElectric ❑Other <br /> °Duplex ©Multi-Famli 4 o Units` <br /> Type of Prt��e,^t. `L7New ❑Addition ❑Remodel QRapatr ---�-•••-- QCommercial ❑lndustria► <br /> DESCRIPTION OF WORK: C]T'I' �SrgnlSlt¢tltteP C7Demolition © hang of Use <br /> RepiaCV Cala4d, 1).12)1.A.O.C.J2... <br /> ASSOCIATED BUILDING PERMIT#(If a licable; <br /> MECHANICAL PERMIT.APPLICAT1OIst <br /> PLUMBING 'I <br /> Type of Project _New Addn Alteration I RMl- PLi ration N <br /> Repair <br /> #of — Type of Project: New ^Addn Alteration TRepair <br /> larfrtra — tf_ollXtursis #of <br /> Lists/Fixtures-__, — <br /> PIS(Ur -. Ofiia"-Of dffttf@1S._—. ...#of ....,.-......., —List-UiC.F{ktttir�@S'—..— <br /> NO—Air}-ianr3ling knits l�cta ores '. �_ �Ifures <br /> forced Alr S stems Heat Pump Toilet <br /> Unik Heater Backflow Preventer Inside Bldg] <br /> Gas Piping Bathtub Urinal <br /> G a Piping <br /> Boiler Laveto Wash Basin)) Drinking <br /> Drain Fountain <br /> Gas Fifie lace Shower Floor Grain <br /> Gas Ran«e Wood Stove Kitchen Sink&Dis osai <br /> Gurtins Grease Trap <br /> Clothes Dr er 1-lookups t7islrwasher #boa#Chains <br /> Ran e.Hood Other; Clothes Washer <br /> Medical Gas <br /> Exhaust Fan Water Heater Other <br /> Sink Servlc&BarfMopietC.) Other; <br /> SPRINKLER't SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein is true end correct.Work done pursuant to this permit must comply with <br /> current federal,slate,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.I am the owner,or I am authorized by the owner of this property to perform the work for which a <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> PPllcatlon Is made, <br /> City of Everett Official Use Only <br /> +� PE - nzi-t <br /> M # <br /> kzosOw,sr/Authorized Ag. Signature Date <br /> ' (Revised 9/2161: <br />