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PERMIT APPLICATION <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN /SPRINKLER I DEMOLITION <br /> Notigi <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> a ?F')425-257-8810 I FAX 425-257-8857 I(E) >eretteas@ eve;ettwa.gov I www.everettwa.gosi ermits <br /> (Blue-orBlack Ink Only Please) '' "PROJECT SITE<INFQRMA 'IOII <br /> PROJECT SITE ADDRESS. q Eq 4©c. <br /> LEGAL for new construction: 3ho-t?latlsubdivision PROPERTY TAX f#: <br /> 1 mC No, ;attach copy of long Legal description) <br /> CONTACT•INFORIM Ail O 1 <br /> OWNER NAME: ' hry <br /> TENANT NAME If Commercial): <br /> OWNER MAILING ADDRESS: STREEr <br /> tip IAA:7 <br /> CITY OA <br /> OWNER PHONE: 4 t STATE i `-`P -1 201 <br /> t Q 0� OWNER EMAIL: <br /> CONTRACTOR NAME: > ° 1 11 C <br /> CONTRACTOR ADDRESS STREET t- oadui• <br /> CITY v. 0 V <br /> IV STATE F lir It. 2eif <br /> CONTRACTOR PHONE: • IP <br /> 60 CONTRACTOR EMAIL-iit A. 4t I —ill (0 <br /> __ +CO#T#�Aat2-k�ICEAl�#€RE�JIt"2.E�:.. �... � � <br /> •�°s L + t t f4 Y OF kV>'R'�'fT S UStN SSLICENSE#tREQtltRED): <br /> PRIMARY CONTACT: 0 OWNER �� fe&r _.._...... <br /> CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> T^'^c^ 1CONTACT PHONE: 1426 2rJ. 3 0�'". <br /> LYii-.- , CONTACT EMAIL: ( 1 m--4 .0 .C <br /> Use of `'7 <br /> =. -.�BtJI[.DING��!E(<tMt7`AF'i��L�ll�`i'1014�` i i� �""': x .' <br /> Existin. Buildin <br /> Contract Price of Work:$ ea' <br /> Proposed Use of Bulidin. ....__ �. <br /> BuildingType: # tl Heat Source: "4 Geo ❑Electric ❑Other <br /> f R-FR ❑SFRAttached ❑Duptex ❑Multi-Family-#ofUnits. —.—__usVai� <br /> Type of''�je:a; QNew DAddifion ❑Remode[ ❑Re _ ❑Commercial ❑Industrsai <br /> DESCRIPTION OF WORK: air CM,. L7Si.lT' C]Sprinkier ❑Demotition © nen"�r of Use <br /> `\cx u 1p as w-1- <br /> ASSOCIATED SUILDING PERMIT# if applicabl � <br /> tvlctakNlcACPlrRrnrr-AerPl.IcaTioN -, ...:: <br /> rype of Project: New Addn PL:UMBIIVG4PERM(:1"s1tt,I L ICAT1ON <br /> _Alteration ,Repair <br /> M. #of Type of Project: New Addn Alteration <br /> #ofRepair <br /> Fi List.oLF.lxturasam= ...-..r L/atB€ r #of <br /> AIC-Air Handlin. Units lXlures Fixtures eefn rras---id:) <br /> Haat Pump <br /> NMIN M Forced Air Systems BathtubTBackflow Preventer lrtsidl3 a)d.) <br /> Gas Piping Urinal <br /> Boiler —Lavatory(Wash Basin)1111111111 .111111111111 1111111. ) Flrinkin• Fountain <br /> Shower Floor Drain <br /> Gas Fireplace <br /> Wood Stove 1.1.11Kitchen Sink&ON easel <br /> Inallo Clothes 0 ' tJishwasher Grease Trap <br /> MIN er Hooku s Other. Medical Drains <br /> Ran.e Hood <br /> _Clothes Washer <br /> ��. Gas <br /> ,�� Water Heater Other: <br /> �� Sink Se ice/Baf!lvlo.letc.) Other: <br /> IIIIII <br /> SPRlNKL R:'/:SUPPRESSION"SYSTEM <br /> -` IIIIIIII <br /> allill Chemical or Water <br /> MI Na.cf Heads MN <br /> ACKNOWLEDGEMENT;f have reviewed this application and confirm the Information contained herein Is true and correct.Work done pursuant to this permit must <br /> current federal,state,and local law. The granting of a permit only authorizes approved work end no deviations therefrom.Deviations must first be authorised in writing from the <br /> Building Official before being authorized under any circumstance.I am the owner,ort am authorized by the owner of this property to perform the work for which application <br /> ishn <br /> and l comply with the State Contractors Law 18,27 RCW and 296.200A WAC. <br /> ode. <br /> City of Everett Official Use Ortiv <br /> ',..iii 1,1 PERMIT# �i <br /> r/Authorized Age . Signature` ' �$ , X // <br /> Ow.a <br /> Cate <br /> (Rovissd Cr2312016) <br />