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APLICATION <br /> oor.„ BUILDING / MECHANICAL/ PLUMBING I SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 96201 <br /> (P)425-257-8310 1 FAX 425-257-B857 1(E)everetteas§everettwe gov( www.everettwa,govipermts <br /> (Blue orSlack Ink Only Please) P RCI SEC C SIT iIVl ORMA`i'iON , �,, <br /> PROJECT SITE ADDRESS- — <br /> di <br /> ( <br /> �' a* # <br /> PROPERTY TAX . I <br /> LEGAL for new construction_ Short Plattsubdrriat; t <br /> Lot No.' (attach copy of long legal description) <br /> CONTACT,INFORMATION 1 <br /> OWNER NAME IA • t <br /> v.` 11►Qr%k ot TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: STR T3 ( w�,o,ji, <br /> �✓` L [✓VCS � <br /> CITY Y Ato....SSTATE Ad• 0' * 0 r <br /> OWNER PHONE: a(60 ao • OWNER EMAIL: <br /> CONTRACTOR NAME: -1 <br /> CONTRACTOR ADDRESS: srnEET 1,4 •d , _ i <br /> CITY " 0 t..t.(.i.l�J • I <br /> n STATE A 7i,� <br /> CONTRACTOR PHONE: L -L 0 So CONTRACTOR EMAIL• , t <br /> s .�r_.� .i 10 -i#_01 no .Gtr <br /> C-G-NTRACTQR ENSEAr`tEOthRE?)! 4 `Cf:t5P-]"� <br /> . . "_..CITY-OP-EVERETT SttSINESS LICENSE-#(REQDIRED)"_ 7. <br /> PRIMARY CONTACT: LYCONTRACTOR 11 OWNER l f'SOTHER(Please Specify) <br /> CONTACT NAME: — <br /> 'Debt uz, <br /> CONTACT PHONE: 42.6 2.513 05SO <br /> CONTACT EMAIL:60040Lk e rtej Co <br /> Existin. Use of Buildin Contract Price of Work:$ ti. <br /> Proposed Use of f3uildin J <br /> Heat Source: ❑Gas ectrio Other i <br /> Building Type: ❑SFR-Detached ■ ttached _ ■ <br /> lMulti-Faml -4' ❑Commercial Olndusfrial <br /> Type of P;olect: ❑New ❑Addi(ion CI Remodel C]Rap 1it OT.I. OShn ❑Sorinkler ODemolition OChange of L1sro <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED I3UILDING PERMIT If of applicable)! ! �C/` <br /> MECH'ANICA .`.PERMIT APPLICATION- 6' <br /> - °'�k.Ut(111�INr7t'ptRIUI�'�'tAaP,LIGATICiN <br /> Type of Project: New <br /> Addn Alteration Repair <br /> It of Type of Project: _New _Addn _Alteration Repair <br /> — <br /> List o xduces �_ #of f!of 1 <br /> ..♦~f'Xrua As "Ff fUr List Of Fixlilre& -r-.„ –Listof-Fixtures tfKeS• #Of <br /> A/C–Air HandlingUnitsFrxtures -- Lse�PFfx€ura�s —--- <br /> HeatPump Fixtures <br /> Forced Air Systems Toilet Backflow Prevenler{lnsi jt B,dg`i <br /> Unit Heater 3a'fttu <br /> Gas Pipin Sailer Un0a1 <br /> Water Heater Levator!(Wash Basin) Drin4 lW Fountain <br /> Refrigeration Shower <br /> Gas Fireplace <br /> Wood Stove Floor brain <br /> Kltoh€n sink Dia t sai Grease Trap <br /> aillIESSIMME C uctinq Dishwasher <br /> Other: Root Drains <br /> F an•e Hood Clothes Washer Medical Gas <br /> IIIIIIIIIIMEMMIIIIMINIMimWafer Heater Other <br /> Sin#c ServiceJE�srlhta /q#c,) Other_ <br /> SPRINKLER-'1..SUPPRES BION"SYSTEM <br /> Chemical or Water No. of Heads <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 /> current federal,state,and local law. The granting of a permit only authorizes approved <br /> Building Official before being authorized under any circumstance.I am the ow ,or!am authorized y the owner of this property to perform.Deviations must s tht e work for Zwhin ich application is is made. <br /> and I comply with the State Contractors Law 78.27 ROW and 296.200A WAC. <br /> City of Q Everett Oficial Use Only <br /> i..�dA /l • t PE \ � O� <br /> f.7w,erlAuthortxaAge� atgnature <br /> Date (Revised 9/23/2CTT6� <br />