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tg9--cti(l q -13 <br /> "IIIP_,A1V—_ PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> ' �'*SNIla CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 90201 <br /> N}425-257-8810 I FAX 425-257-8557 1(E)averetteps@everettwa.gov gov I www.everettwa.gov/permits <br /> (Blue or'Black tnkot Please) Ptt :JECT'•;SI"!"EUP i Nlil`'tlt_hlr :°._er <br /> PROJECT SITE ADDRESS: , * M<r re r� <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short P(at s bdi�risEun <br /> —.--.- Lut No. (attach copy of long legal description) <br /> CONTACT INFORMATION , ' <br /> OWNER NAME: �j,r^q �/9�,�.��-+ <br /> l Q^"°r 4L t 4 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTaEET HJ (i, 03.).e- <br /> ____ <br /> • <br /> / , <br /> 114 <br /> CITY <br /> _-_ :...�,. .ni! ...:....A.A. STATE V V A ZIP # a fir <br /> OWNER PHONE: �yj'� Lic- <br /> �ge ,,, gyOWNER EMU.: <br /> CONTRACTOR NAME: () ' l V:.4p.u* �? W <br /> , i`' r1 lil C. <br /> CONTRACTOR ADDRESS: STREET 14Y'Ot:.t <br /> CITY 6) �'�/YL+ �..7 ...__..._�.__.... {y(J /`� <br /> STATE f-- ZIP t��L Ct 21„i 1 <br /> CONTRACTOR PHONE: 1_,2 e zro ct. C.) 60 CONTRACTOR EMAILA J.plz`a . L UYI a` fiC •cam <br /> CONTRACTOR-LFGESSE ,REQHtRED): ESR <br /> L-�Jf �� - CITY-OP EVERETTBdSINESSCtCENSE#(REClIl1RELl):1C.l(f,CI <br /> PRIMARY CONTACT: ❑ OWNER (YCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4. s 2,5 ' �O S <br /> TJ -���,CONTACT EMAIL: afo a ,,keGLl • .I..oni <br /> , _ aUILDING.PERMI'okptfolo irioNl <br /> Existing Use of BuildingContract Price of <br /> Work:$ -2•50 — <br /> Proposed Use of Buil;tg, Heat Source: 1136as ❑Electric Omer <br /> Building Type: FR-Detached ❑,SFj -Attached ❑Duplor ❑Multi-Famfty#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ClRemodel ❑Rapair ❑T.I. OSign ❑pr nkler ❑Demolition ❑Change or Use <br /> DESCRIPTION OF WORK: <br /> 115---cd <br /> G1s IV sem <br /> ASSOCIATED BUILDING PERMIT#(it applicable): <br /> MECHANICACiPERMITAPPLICATION ';,',, , ' A,4. ,, <br /> Type of Project: New ro4 �•�1?N{t3�[lC ' C14111 "ti !#?I»[CiATtt3Id <br /> Addn Alteration iRepair Type of Project: New <br /> If of <br /> 4 of j Addn _Alteration Repair <br /> yefxtorv�s JsLoLFtxttrre5 L1Sl.ot EJxtuses #of <br /> tuT6::___ ---s4 of —� List ofFixttrres—.—_. #of <br /> -List of Fixtures <br /> A/C-Air Handling Units FteaE Pum Fixtures <br /> Aj ceti Alr a stems To'iet Backflow F�reventer Inside gldc j <br /> Unit Haater Bathtub <br /> Gas Pipit�s� Boiler Urinal , <br /> Water Heater Lavatory(Wash Basin) Drinking Fountain <br /> Refrigeration Shower <br /> ( Gas Fireplace Wood Steve Floor Drain <br /> Gas RancJe <br /> Kitchen Sink&Dis osal Grease Tra <br /> L7u`'Uncj Dishwasher <br /> Clothes Drrer Hookups Other. <br /> Roof Drains <br /> Range Hood Clothes Washer (viedical Gas <br /> Exhaust Fan ���Waier Heater Other: <br /> __� 5ink Se�rvlcelBardtvlo�/eic.} Qther: <br /> SPI2lNKLER'1;SLIPPRESSION.SYSTEM.,,.. ,,. <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.shave reviewed this application and confirm the Information contained herein is true and correct. Work done pursuant to(hispermit must comply with <br /> current federal,state,and local law. The granting of a permit only authorizes a <br /> pin <br /> Building Official before being authorized under any circumstance.1 am the ow err <br /> or! m authorized byoved work and no rthe oowneens throf this property to performDeviations muststheework forzwh ch application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200,4 WA C. <br /> City of Everett Official Use Only <br /> ri 77411771-------------,T, � <br /> ow,or/Authorized Age 1�Signature <br /> 9 Signature Date <br /> ' (Revised W23/201 ) <br />