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PERMIT APPLICATION <br /> BUILDINu i MECHANICAL! PLUMBING ! SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 4:11 <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everettepsaleverellwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) - PROJECT,SITE'ANFOEINIATIONf'W-f- <br /> PROJECT SITE ADDRESS: V)045 ' ator\j2k .AN,>-4_,,,' PROPERTY TAX#: <br /> LEGAL for new construction: Short PlaUsubdivislon Lot No.. (attach copy of long legal description) <br /> .. <br /> CONTACTINFORMATION <br /> OWNER NAME: , .. .... * Clip TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY ety2,44,a- STATE '044_, ZIP :jtt <br /> OWNER PHONE: "a.- ,' is t OWNER EMAIL: <br /> CONTRACTOR NAME: Din 0.efaiirtrc. <br /> A in c <br /> _ <br /> CONTRACTOR ADDRESS: STREET 1 Li't faroaaLk.90- <br /> city or t STATE A A- ZIP g : '1111 I <br /> CONTRACTOR PHONE: 1.--Ls 2. 3q 05SO CONTRACTOR EMAILA)„ik)07 P..., oryth,e_rj n9 .corn <br /> CONTRAGTOR-LICEN-SE-IV,REOURED-): . 14- - CITY OP BVERETT13USINESS LICENSE#(REOUIRED):-I 0(gig -- <br /> P121MIAW011-FAC-1: ET(31.ATN'EP7 tVw --------------7-------------------CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 4.2.6 zsci os--D <br /> CONTACT EMAIL:60310 a e tetea+t c.orv7 <br /> BUILDINGFiktRIVilt:APOtitATiONerT7 :,-:.-:',",.reff,':"''',• ' '' - <br /> ,.. <br /> . . <br /> Existina Use of Buildlml; <br /> Contract Price of Work:$ QO <br /> _ . <br /> Proposed Use of Building. <br /> Heat Source: Er6as III Electric DOther___ <br /> Buildin• T po' Mk's'FR-Detached DSFR-Attached ODuple',: OMulti-Farrill -It of Units DCommerclal [Industrial <br /> Type of Project' DINew CAddition 0 Remodel 0 Rapair T.I.DOSign OSprintler ODemolition Ochange of Use <br /> DESCRIPTION OF WORK: <br /> i/154.6w he 01, @as c‘A.vnct6.6 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION , ! ,'1 ' '. ' ,=.' '' '''',PLUIVIBINII''PERIVIItAPPLICATION <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> ... <br /> If of <br /> #of <br /> #of <br /> _Lis tofFixtoces„._ 1.ist-of Fixtures— #of <br /> List-of Fixtures-- —L-ist-of Fixtures-— <br /> Fisk-turas- ' -HOW§t----- Tixtures Fixtures <br /> NC-Air Handling Units 1 Heat Pump Toile( Back low Preventer(Inside Bldg) <br /> i, [ <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> , <br /> Gas Piping <br /> Boiler _ Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration <br /> . <br /> Shower Floor Drain <br /> Gas Fireplace iWood Stove - kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups , Other: Clothes Washer Medical Gas --- <br /> Range Hood <br /> Water Heater Other: <br /> Exhapst Fan <br /> Sink(Service/Bar/Mop/etc, Other: <br /> —,---7—'------------ <br /> SUPPRESSION:SYSTENI <br /> Chemical or or Water --------"Na of Heads <br /> ACKNOWLEDGEMENT:I have re wowed thin appliostinn and confirm Ow in/urination wni'mooci hereto is true and correct.Work done pursuant to this permit must comply with <br /> currant federal,stole,and local few. The granting of a permit orti7 authorizes approved work and an deviations therefrnm,DecmitattS must first be authorized in wilting horn his <br /> Building Official before being authorized under soy circumstance_tam the owner.or I am authorized by the owner of thiS PrOPartY to perform Om‘°"01'for wiiisti sPrnicfiliO'is ire/is <br /> and I comply with the.State Contractors Law 18,27 ii*Clii,ebd,296.2.00,141401C, <br /> City of Everett Official Use Only <br /> I PERU1T a .- <br /> 1 ri 1 )CiPt----. 0( (a <br /> Ow i er/Authcrized Age- Signature <br /> Date <br /> (Revised 9/2312016) <br />