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PERMIT APPLICATION <br /> OLT* BUILDING / MECHANICAL I PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or'"Black Ink Only Please) <br /> ) ' ,pFtCJJ> OT-StT;ANFOMAY1ON Vi:a' <br /> PROJECT SITE ADDRESS: k O l •••10 ..a`,fit `t ... ' <br /> � f if PROPERTY TAX 4: <br /> LEGAL(or new construction: Short Plat subdivision t <br /> / Let No. (attach copy of long legal description) <br /> CONTACT`.INFJRMATIOH , = r— .. <br /> OWNER NAME: ,fit <br /> Com` 'e, Y"1 TENANT NAME(If Commercial); i <br /> OWNER MAILING ADDRESS: sTRCET 4 <br /> E S o MIk 1 0 <br /> 0- - srATC LP 41' <br /> OWNER PHONE. 5 <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: 0 I i n 111 C' <br /> CONTRACTOR ADDRESS: sTReET 1 4 ro rOet,CLUc <br /> CITY _ STATE VY i r 7_IP L? Y.�1..1 L 1 ._._..... <br /> CONTRACTOR PHONE: 2_5 1�ct t 60 !CONTRACTOR EMAIL: Q C y - tn. •Go <br /> nci <br /> _O047FAGTOR-NCENS~4t,REE{4tRED _Cp RV ` i CITY.CPtERxTT8t95tIESStfCEWSg#(REQttRED). IO PPRIMARY CONTACT: 0 OWNER + CT OTHER <br /> (Please Specify) <br /> CONTACT NAME: [CONTACT PHONE: <br /> -.���ZS 259 05� <br /> CONTACT EMAIL: n t,.1..,t e r�LQ, 'CO ' t <br /> BCI�y 5 �ip1�• y$y. y. pyo <br /> ILtiING=�'►-i�'17r1 �;t�Iw/1 '� <br /> Existing Use of Building ^� „�, <br /> Contract Price of Work:s J ac—No <br /> Proposed Use of Buiidin� <br /> Heat Source: Ai IIElectric ❑Other <br /> Building T,pe: El SFR-Detached ❑SFR-Attached ❑Duplex ❑Mufti-Famil 4 of Units: ___ <br /> _-_--,_ . .__._ ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel I IRepair DTA, OSin DSprinkier ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK. <br /> ? ç — c-e- <br /> C5-71 5-FurnaCsL <br /> ASSOCIATED BUILDING PERMIT 4(if ap 9pcahie): <br /> MECHANICALIPERMII APPLICATION <br /> Type of Project: New : 'N. +NGRhA ;P,LICA1'10N <br /> Addn Alteration _Repair """ """' <br /> #of I III II #of Type of Project: New Addn Alteration <br /> _Repair <br /> _ txtxtvras- ' fJxl.ofFtxturea #of #of <br /> 77kTur fi Lisr`clf Fixture List-of-Fixtures--_..—,.. <br /> F'ixturas��� _.... _ _ <br /> AJC—Air Handling Units Heal Pumt. Fixtures <br /> Mi�Forced Air Systems Taill Backllc-�i Prevenfer Inside Bldg) <br /> Unit Heater Bathtub <br /> boiler Urinal <br /> ()Lavatory(Wash Basin} UrinicinFountain <br /> __' Refrigeration Shower <br /> Wood Stove Drain <br /> Gas Range Kitchen sink&Disposal GGreerease Trap <br /> jrHookups Ducting <br /> Mill Clothes Dr Dishwasher <br /> Other Roof Drains , <br /> Range HoodMM. <br /> Clothes Washer Medical(ass <br /> Exhaust Fan IA(aterHeater the — <br /> Mal Or: -- -- <br /> Sink(5arvicel8arlMoraletc.) Other; <br /> 111.1111111111111111111111111111111.111111 <br /> ' SPIiINKLER-f>SUPPRESSION SYSTEM <br /> 1111111 Chemical or Water 1111111 No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein Is bue 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 work and no deviations therefrom.Deviations must first be authorized in writing from <br /> Building Official before being authorized under any circumstance./am the owner,or I am authorized by the owner of this property to perform the work for which appltcaliom the <br /> on is made. <br /> and I comply with the State Contractors Law 18.27 RCW and 295.200A WAC. <br /> q <br /> City of Everett Official Use Only <br /> j:., L(} Al....-. <br /> , 2,1 • I c6 PERMIT • :?. t <br /> •n ure 'I 1 t JJ�� L' <br /> Owe or/Authorized ed Age Signature )l/i 0 S,' <br /> Date (Raysed 5123/20W) <br />