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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER ( DEMOLITION <br /> +*II!' CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)evenetteps c7everettwa.gov I www.everettwa.gov/permits <br /> (Blue or'Black Ink'Only Please) 'PROJECT 81' IIUFc 10A`>aIoN ,,,,' <br /> PROJECT SITE ADDRESS: 3 rte- Terra C� <br /> 10 ..- PROPERTY TAX 4: t <br /> ' <br /> LEGAL for new construction: Short Plat/subdivision <br /> Lo',No. (attach copy of long legal description) I <br /> } <br /> CONTACT.INFORMATIOkd" <br /> OWNER NAME: ,kj S t die..... TENANT NAME(11 Commercial): <br /> OWNER MAILING ADDRESS: <br /> STREET ..ex • <br /> CITY ` }. <br /> � j STATE zip <br /> OWNER PHONE: L4 .5- Oj 3ca }OWNER EMAIL: <br /> CONTRACTOR NAME: ( r\ 1n c. <br /> CONTRACTOR ADDRESS: STREET l`. foroc,,,.ctu <br /> ool <br /> cizv <br /> f� O�' ' STATE - IiP �20 <br /> CONTRACTOR PHONE: L2.5 6 C5 0 JCONTRACTOR EMAIL <br /> a l:2 e.. Go'1,1''1za""tIfIC� .(0 <br /> ___CONTRACTOR-LIGENSE REQk.IlRED).. - T' p t'7� ""1CITY OF EVERETT USiNE LICENSE#(REOt3IRED1:J-f 0(04 K_ <br /> PRIMARY CONTACT: 0 OWNER I 'CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4,2s 2,5c1` O�* SC) <br /> CONTACT EMAIL:dp tat,,.�a e ,—rt,eGk,1 t< • .CD <br /> BtJlLDING'PERMITAPOOtt ' iON n' •zd. .,r'b. . . _ <br /> Existin. Use of Building: <br /> Contract Price of Work: $_ 43 O <br /> Proposed Use of Building: <br /> Heat Source: ❑Gas 01-1`"ectric ❑Other <br /> Buildin T pa: rr FR-Detached ❑SFR-Attached ❑puU 1e+ _._ .. <br /> ❑Mu9tl•Famtty-#}ofUnfts: ❑Commercial ❑Industrial <br /> T'pa of Project: ❑New ❑Addition ❑Remodel <br /> DESCRIPTION OF WORK: CIRe qtr ❑T,i. ❑Sin 11Sprinkler ❑Demolition ❑Chan e of Use <br /> n5 -(611- 412 <br /> ASSOCIATED BUILDING PERMIT#(if asplicahlel: <br /> IMCJBCNitINtGAL Fear "a4PP IGATItON "� , <br /> PLUMBIN P'ERMi r PL1CArJON <br /> Type of Project; New Addn �" ' <.. ,. i° <br /> _ Alteration Repair <br /> #of — Type of Project: —New _Addn —Alteration Repair <br /> Ptxtrnnrs- <br /> List olFixttrres #of #of <br /> f <br /> Forced Afr Systems rsl.o ,Fixtures _ _. .— Lls(�t-fixfnres - #of <br /> Fikfures t jxturas �fst of Fixtures— —._—. <br /> A.IC —Air Hantilin. Units Heat p,�mF Fixtures <br /> YUnit <br /> Toilet Backflow Preventer Inside t is) <br /> Univ Heater Bathtub <br /> Gas Piping Boiler Urinal <br /> SteFr'Haeater _,,,. T t 8�ataly (Wash Basin [rinkit� Fountain <br /> Refrigeration Shower <br /> ._...-- Puce <br /> Wood Stove Flr}or Drain <br /> Gas Rano e Kitchen Sink L�Disposal Grease Tra —``"-- <br /> ClothClothes Dryer Hooku s Ductinrj Dishwasher p <br /> e Hood Other: Clathes wast-- ------ <br /> ------ <br /> ashRoof prams <br /> Water Heater MeclicaE Gas <br /> t_xhattst Far;---- <br /> .______________p_ <br /> an �`" Other: <br /> Sink(Service/Bar/Mo /etc, Other. -- <br /> ' SPRINKLER'/SUPPRESSION SYSTEM , <br /> • <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application end confirm the Information contained herein/s true end correct.Work done pursuant to this permit must cami with <br /> om the <br /> current federal,slate,and local law. The granting of a perrnif only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writin <br /> Building Official before being authorized under any circumstance.I am the owner,or I am authorized by the owner al this property to perform the work for which applicaflon is made. <br /> g fr <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAD. <br /> City of Everett Official Use Only <br /> ,AA i -11 -10 PERMIT# <br /> O. sr/Authorized Age. signature t �� i (:), <br /> ' ' <br /> Date � (�L� <br /> (Revised 4,1231207&) <br />