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P <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN 1 SPRINKLER 1 DEMOLITION <br /> Ar CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 1(E)overelteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITEINFORMATION <br /> PROJECT SITE ADDRESS: 3109 „..910-6 <br /> ave., PROPERTY TAX#: <br /> LEGAL for new construction: Short Mat/subdivision <br /> Lot No.i (attach copy of long legal description) <br /> CONTACT-INFORMATION <br /> OWNER NAME: / J1 f"t i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 10' # 41' r1 <br /> ter' "tr., J 1 /9"-- <br /> CITY `+1� STATE t/ 21P . <br /> OWNER PHONE: r. '1 + <br /> Ic 1+` s OWNER EMAIL: <br /> CONTRACTOR NAME: ii YI (C� .�, "� <br /> CONTRACTOR ADDRESS: STREET t 14 1tro&t.�1.i-& <br /> CITY 1,Q 11” k�.(j'( �}t+ <br /> LC• STATE `+- ZIP. L L7 20 i <br /> CONTRACTOR PHONE: L-�'S j CI C,-. 60 CONTRACTOR EMAIL <br /> �- `L e., � <br /> ����(�1� t_ n9 .care <br /> CONTRACTOR-LICENSE#REQUIRED):'-" , t - f ^C 5 f7+ CITYO> EVERETTBUSINESS LJCENSE#(REQUtRED): 10(ys g <br /> PRIMARY CONTACT: 0 OWNER teCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( -2S 259, <br /> OGJ' O <br /> TL CONTACT EMAIL: , . ,� a +14041 # ,CD <br /> BUILDING PERMIT'APPLICATION f77 <br /> Existing Use of Building: Contract Price of Work: _ ,....>c)-,,, <br /> Proposed Use of Building: `� <br /> Heat Source: ❑Ga$ ❑Electric ❑Other_ <br /> Building Type: it SFR-Detached ❑SFR-Attached ElDuplex OMulti-Family-#of Units:_...._ ❑Commercial ❑Industrial <br /> T e of Project: ❑New OAddition ❑Remodel OReuair DTA. ❑Sign ©prinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION bF WORK: <br /> qce.,,,,,a <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> i MECHANICAL PERMIT APPLICATION , PLUMBING'PERMITAPPLICATION <br /> Type of Project: Naw Addn Alteration _Re air <br /> ft of p Type of Project: _New _Addn Alteration _Repair <br /> /ts[.pfFtxtures_ _ tt of it of <br /> Fixtures- _.._ Ft 7iires List.of Fixtures-- List-ofFixtures . .. #of <br /> Fixtures es __..._- List of Fixtures <br /> NC—Air Handling Units Heat PumpFixtures <br /> Toiletht 'Backflow Preventer(Inside Bldg) <br /> I Forced Air Systems Unit Heater Bathtub <br /> __-__ Gas Piping Urinal <br /> Boiler Lavatory <br /> Water Heater a; (Wash Basin) Drinking Fountain <br /> Refrigeration Shower <br /> Gas Fireplace Wood Stove Floor Drain <br /> Gas Range Kitchen Sink&Disposal Grease Trap <br /> Clothes Drier Hookups Dur,[ing <br /> Dishwasher <br /> p- Other: Roof Drains <br /> P.an e Hood Clothes Washer Medical Gas <br /> Exhaust Finn -------------7-Tar—=_.:11-1:1------7:1:- <br /> , <br /> Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM - <br /> Chemical or Water No.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 /> current federal,stale,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 /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use r)miv <br /> A PERMIT#• <br /> O Y <br /> 4 1 <br /> Ow,et/AuthorizedAge- Signature <br /> Dale (Revised 912 12 76) <br />