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I <br /> PERMIT APPLICATION <br /> 41ErrBUILDING / MECHANICAL/ PLUMBING I SIGN /SPRINKLER (DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-5810 I FAX 425-257-8857 I(E)everatteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or'Black Ink Only Please <br /> 'F'FL4JECT SITEINFtSftMA`rft}N lW0W.° <br /> PROJECT SITE ADDRESS: 72o \s. , 1� —I <br /> • e. D VC�,� iPROPERTY TAX#: i <br /> LEGAL:ur new construction: Short Piatisubitivis,Do <br /> - Lot Pio. (attach copy of long legal description) ICONTACT:INFORMATION' , - _x . <br /> I <br /> OWNER NAME: 1-l' • <br /> #i' _ TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: <br /> =`= > LI ice: '' , tl ,. <br /> rV � S [ -tG # srATE c, <br /> OWNER PHONE: Ot+CI OWNER EMAIL: <br /> CONTRACTOR NAME: CO) InCONTRACTOR ADDRESS:: sTnF_? 1corn .•b , _ <br /> CONTRACTOR PHONE: U 1� `C `• STATE r� g g I <br /> CI C) 5O CONTRACTOR EMAIL•.,,A. 4 ,, I Aik ../1,00:11(4 •cony <br /> CONTRACTOR LICENSE-#-F4EQUlRE13):C qr 4.Nsc —y l R —CITY OVER -BUSINESS'LICENSE-#(REDDIREDy:—`136 CI-p---- <br /> PRIMARY CONTACT: 0 OWNER (VCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: wCONTACT PHONE: 1425 2_5 c O D <br /> S/ CONTACT EMAIL:C�a (�j C, l ke <br /> ING.'PERMIT 4Fsk.tlrolos ,,,,, ,- , ,,- r , t <br /> Exiating Use of Bu:ldin9: <br /> Contract Price of Work: $ are• La a <br /> Use of Building: <br /> or <br /> _.. . <br /> _Heat Source: OGas trip OOther am <br /> BuildingT}pr.: R-Detached ❑SFR-Attached OOiuplsx O .tutti-Farnil 4 of Units: `, <br /> OCommercial Olndustrial <br /> Type of toro)eot: ❑New ❑Addition El Remodel ORepir DLL O; tg t OSnrinkier El Demolition DU-tangs of Use <br /> DESCRIPTION OF WORK: <br /> M r cUU 1n,. - p wmQ O,d ccg. icind1-1ep. <br /> ASSOCIATED BUILDING PERMIT#`. <br /> 4lfapPi[catale): <br /> MECHANICAL=Isl t I1+J17 APPLICATION <br /> TYPe of ProJect: New Projec: IX°Addn }Alteration <br /> Alteration Repair <br /> of 'Type of Project: New _Addn Alteration _Repalr <br /> L.ist.a.Fixtuce.S_ #Of #of <br /> tsiuras — List of fixtures d f5€PF is tut #of <br /> Ftzt0re5 -- reS <br /> A/C–Air HandGn lint Fixtures Fixtures {rgt of —----- <br /> Heat P�rnr Tciiet <br /> Forced Air Systems Unit Heater Rarkflow Preventer Inside E3id "i� <br /> Gas Pining Hathttib Urinal <br /> Water Heater R tlerrig LavatoryWash basin <br /> Refrigeration ( ) Drinking Fountain <br /> Gas Fireplace Shower Floor Drain <br /> Woad StoveKitchen Sink&Dir <br /> Gas Ranr�e CluctinQ posa! t3rease Trap <br /> Clothes Dryer Hoakuns Dishwasher Raor drains <br /> Ran a Hood O`lher: Clothes Washer <br /> Exhaust Fan Water Heater Medical Gas <br /> Other: <br /> Sind(Servical}aarJtvgop/e#a.) Other. <br /> ___,_________SPRINKLER SUPPRESSION,SYSTEM <br /> Chemical cr tiA+iter Nc.of Heads <br /> ACKNOWLEDGEMENT I have reviewed flu;epANcnrh n and rnn i rn theinformation contained herein is true sad correct.Work done pursuant tc this perm+t must <br /> current federal,slate,and local law. The granting of a permit only authorizes approved work and no deviations therefrom,Deviations must first be authorized in wtUn <br /> Pudding Official before beingauthorizednyComply vitlr <br /> and i i rg Of fi i with the tate Lauzs under any circumstance, <br /> ROW end 9C.2C the <br /> WAC <br /> orient euthodmiy the Y Ifi L€xrraer cf this property to perform the r.+. tris which appliralicn to r�;acfn <br /> City of Everett Official Use Cnty <br /> . LQ k o .tet . P Mf <br /> •Ow,eriAuthorized Age- Signature 46 ' <br /> C7a:e (Revised 9/2312076) <br /> `. <br />