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PERMIT APPLICATION <br /> 0111477. BUILDING ) MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everelleps@everettvva.gov 1 www.everettwa.gov/permIts <br /> (Blue or'Black'Ink'Only Please) 'PItC1JEGT=At"r`;ttlftFORIViAt1ONPe .f, .ks..f.i;,1:- <br /> PROJECT <br /> , .PROJECT SiTE ADDRESS: 53 0 t W Hist,I ! 41 <br /> '�"��' GA. * PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlst,hrtivition <br /> ---... Lot No.' (attach copy of long legal description) <br /> CONTACTzINFORMATION ." ' <br /> OWNER NAME: $►[ V ' <br /> C t+ }� <br /> 1 4 r+ TENANT NAME(if Comt»erciat). <br /> OWNER MAILING ADDRESS: STREET Sot Ai kh <br /> r,/A, <br /> // yy y./. L.f.,./�i t STATE ziP i�' »0 <br /> CITY <br /> OWNER PHONE: 12 6730 0 OWNER EMAIL: <br /> 1 <br /> CONTRACTOR NAME: " t r 4- r' Inc <br /> CONTRACTOR ADDRESS: STREET t 4 4 i5 broa.ctixo-ki <br /> eITY +1111.. + __*;k; STATE A A— ZIP r s # <br /> CONTRACTOR PHONE: L2.5 Zc- + <br /> c t 0560 CONTRACTOR EMAIL°. ..t� 4 , s l ! at t f a •co <br /> —_ Cly 4TRACTOWLIC-ENSE-#(REGUIRED): ' ;- SR..j—_-CITYr EVERETT"BUSINESS LICENSE#(REQUIREO)'-/06:7-crg <br /> PRIMARY CONTACT: D OWNER LCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: t42.6 251J 05S0 <br /> CONTACT EMAIL:at...div artA Com' ' t <br /> ' ' , .' ,'BUIL.DINIGTR.RMitgAE I'?! '.f"1Alt'I.. "r'� *��.i a•,�"., _ <br /> Existing Use of Building: Contract Price of Work:$ Q O <br /> Proposed Use of Building: <br /> Heat Source: ❑Gas , <br /> �tiectric ❑Other <br /> Building Type: FR-Detached ❑SFR-Attached ODuptex ❑Multi-Fatuity-#of Units: DCommercial Dlndustrial <br /> Type of Project: DNew DAddition ❑Remodel DRepair DT.I. DSign DS.rinkler DOemolition DChan a of Use <br /> DESCRIPTION OF WORK: <br /> ( 11 -i-Ctki., k9-Ak— erve <br /> ASSOCIATED BUILDING PERMi pm <br /> T#(if a��plfeabie): <br /> yrre��MECHi4NICAL:PEI Ml APPLICATION <.:'_ ; <br /> T Project: New Addn _Alteration _Re air <br /> p of p Type of Project: _New _Addn �Alteration _ftepalr <br /> tt 4tLF}ztuces #of #of <br /> .0,5,4„„,...—.-- Ffzt Ji s List-ofF--txxtures-. List-ef-Fixtures #of <br /> A/C-Air Handling Units Heat Pump txtures Fixtures -List ofFCxfures —_._—. <br /> Forced Air Systems J Unit Heater Toilet Backflow Preventer(inside Bldg) <br /> Gas Piping Bathtub Urinal <br /> Boiler +Lavato (Wash <br /> Water Heater Refrigeration ShowerYBasin) Drinking Fountain <br /> Gas Fireplace Floor Drain <br /> Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Range DuctingOishwasht t p <br /> Clothes D er Hookups Other: Roof Brains <br /> Range Hood Clothes Washer Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other; <br /> SPRINKLER SUPPRESSIC7N.SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:i have reviewed this application end confirm the Information contained herein Is true and correct.Work done pursuant to this permit must comp!y 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 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 application is made, <br /> end I comply wlfh the Stale Contractors Law 18,27 RCW end 295.200A WAC. <br /> City of Everett Official Use Only <br /> ....4410 [ PERBT# 1 <br /> OW arJAuthorixtfd Age Signature <br /> Date , (Revised 9123120/6) -1 <br />