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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (f)425-257-8810 I FAX 425-257-8857 1(E)averetteps4eve�tettwa gov I www everettwa,govtpermits <br /> (Blue oeBlatacic InykPlei,ittt!a- ptt0�' T V <br /> PROJECT SITE ADDRESS: IF <br /> ; _ PROPERTY TAX#: <br /> LEGAL for new construction: ShortP atisubd vision lx>t No.` (attach copy of long legal description) <br /> Oft:NAME: <br /> Pr t 1 .. t"t1r' . i. <br /> I. TENANT NAME�jf:Crrrrtr rejegt <br /> OWNER MAILING ADDRESS: STREET 143 a tf it arriOrti'+ <br /> Ct1Yefet° ... STATE ' ZIP g2O r' " <br /> -OWNER PHONE: 45 +Z.:' <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: l , ,. n( <br /> CONTRACTOR ADDRESS: STREET 14 ro4,* �p <br /> CIN STATE ZIP ` <br /> CONT[ TOR PHONE:4 q•. Q CONTRACTOR Emki4jkititn4 <br /> CONTRACTOR LICENSE# TIRED},C, , ^ " • •, , CITY OF EVERETT BUSINESS LICENSE i ECIU!RED) . C(pct <br /> PRIMARY CONTACT: 0 OWNER IOONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE 2.S 2.5c7 cie-C) <br /> CONTACT EMAIL <br /> E <br /> /*i`BUil tinittlOt,A0 -" � <br /> !'�- - 'Contract <br /> �� .r,.�. ��i, , , , ^_ <br /> Existing Use of Buildi tract Price of Work.-; % <br /> Propnsed Use of Budding: Heat Source ABS ❑Electric ❑Other <br /> ButildititiTYpa: FR DeJEhed ❑SFR-Attached OOuplex, ❑Mutt Famlly of1Jnits; ., ❑Commercial ❑Industrial <br /> Type of Projects ❑New DAddition ❑Remodel ORO* ❑T.I. L SigOSprinkler ODemolition ❑change of Use <br /> DESCRIPTION OF`WORK: ` n..� �' <br /> Run t p P`f n9-i-ED n qas 1 v ett t vtSi i t:1 nam Tas <br /> I nye rt <br /> ASSOCIATED BUILDING PERMIT$Of apglioahtey, <br /> , <br /> MECHANiCALIPERMiT•APPLICATiONNew Addn I <br /> :=PLUMBNG iER pPLICATIkN - <br /> Type of Project ,- ' - 1 O <br /> �rattccritY, Repair Type of Project New Addn Alteration _Repair " <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 Pump ToiletBackflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub: Urinal <br /> GasI Piping p 8 oiler Lavatory-(Wash Basin) Drinking Fountain <br /> Water Heater - Refrigeration: 'Shower 'Floor Drain <br /> i Gas Fireplace Wood Stoye�' :;; Kitchen Sink 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 <br /> TiliCeBaclMoletc.) Other; <br /> - SPRINKLER 1 SUPPRESSION.SYSTEM: ,,_ <br /> Chemical or Water I INo.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 /> tra reiirfedorai slate and local law Tits granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> so**Ipb ati}ell ra being ailihouiiedilndor any cktutrtgrance.I am the owner,or!am authorized by the owner of this property 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 /> C##tofEverett Official Use Only <br /> PERNIVen <br /> I <br /> C? fAuthorizol# 1 <br /> A, $tgr>atuta; • Date <br />