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PERMIT APPLICATION <br /> 4reErrBUILDING I MECHANICAL/ PLUMBING I 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 1(E)everettepsgeverettwa.gav I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE.INFORMATION <br /> PROJECT SITE ADDRESS: L/(p07 t iVii „I� <br /> LEGAL.for new construction: Short<'Iat,,K�t�div'tsiore�. PROPERTY TAX#: <br /> ------. FcT Nm._n.. (attach copy of long legal de ....lonj <br /> CONTACT INFORMATION" <br /> , <br /> OWNER NAME: 1 . 4 <br /> / 0 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STIR RE- LJ o (r` i <br /> ciTv i_r �.(� <br /> OWNER PHONE: �� • t#r3 STAT zip 20 <br /> + "77 a OWNER EMAIL: <br /> CONTRACTOR NAME. `41 I f t{ri C <br /> CONTRACTOR ADDRESS: ,1 0& <br /> STATE. , LIP tIr : 0 1 <br /> CONTRACTOR PHONE: � SO CONTRACTOR� 0 ,r.«+ + <br /> EMAIL'� t d 'i • 411 .•:A I ftsN ..Co <br /> CONTRACTOR LICENSE#(REOLJi2f�E3): i s ;r� �t <br /> CtTY OF EVt REIT i$SUSIUESS LICENSEti(REQUIRED) { its Ck <br /> PRIMARY CONTACT: 0 OWNER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> J Lk • 1 CONTACT PHONE: 4.26`J. � <br /> ZStVekl ? � D <br /> CONTACT EMAIL: . AR R • CO <br /> BUILDING-PERM!rAPtKKATIE l " <br /> Existing Use of Building: <br /> Contract Price of Work: $ <q3 <br /> Proposed Use of Buildin.: —..._,_ <br /> Building Type; ►' Heat Source: ►w'as DElectric DOther <br /> SFR-Datached DSFR-Attached DDu lex DMuitl- ____.Industrial- _____ r_ <br /> p Family_it of Units; __ _ DCommercial ❑Industrial <br /> T +e of Protect: ❑New ❑Addition ❑Remodel DRepair ❑T.l. DSi.n DSornkler ❑Demolition ❑Chan a of Use <br /> DESCRIPTION OF WORK: <br /> , r--• <br /> I la..02, TS TOrn.ac.e_., <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION <br /> Type of Project: New A7,17-7=0,777.177,7--- t'LUMSIt+Id'PERM�'I" 1�!!PLlC,4TIaN <br /> #of Type of Protect: New gddn _Alteration Repair <br /> Ffxtums _f�1�t..ofFixfutes _. #of #of <br /> 1ixTures_ 'Mt of-FlxWres-- -. .— List-of Fixtures ..__.. #of <br /> A1C-Air Handling Units Heat Pumn fxfures — fe — --L1st oFfiiew." <br /> Ffxtures <br /> Forced Air Systems Bathtub <br /> Urinkflow Preventer(Inside Bldg) <br /> Unit Heater Bathtub <br /> Gas Piping Boiler Urinal <br /> Water Heater Eavatony(Wash Basin Drinking Fountain <br /> Gas Fireplace Refrigeration Shower <br /> tNood Stove Floor Drain <br /> Gas Range Kitchen Sink&Dis oral Grease Trap <br /> Cilit7s DDryar Hookups Dining Dishwasher <br /> CJtherRoof Qrains <br /> ngra Hood Clothes�t'Jes#1eriv--------- -------- <br /> _____23,_a Gas <br /> Exhaust Fan Water Heater Other. <br /> Sink ServloefBarfMnp�efe,) 4)fher; <br /> SPRINKLER'/SUPPRESSION s1f` TEIYt <br /> Chemical or Water No.of Heads <br /> ACKNOWLED,state,and local law.The GEMENT.I have reviewed this application and confirm the information contained herein is true end correct.Work done pursuant to this permit must comply with <br /> current <br /> BuildingfO ial before being authorized under'any cof ircumstance.i am the owner,or I am authodzed by the owner of this property to perform the permit only authorizes work <br /> work and no deviations therefrom.Deviations must first be authorized in whling from the <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> for which,application is made. <br /> Oily of Everett Official Use Onty <br /> PERMIT <br /> I l I �•"(". <br /> 0jt ( o ►.1 3•Z7 13 er/Authorized Age Signature Date <br /> (Revised 9/23/2016) <br />