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PERMIT APPLICATION <br /> '� BUILDING/MECHANICAL/PLUMBING/SIGN I 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 11Eyeverettepstaeverettvva.gov i www.everettwa ov/ ermits <br /> ('Blue or Black Ink • Pt+ feCtI E IHFO MVIAT1Ot+L <br /> PROJECT SITE ADDRESS: 127 DOA I,e4' ve PROPENIY TAX#: <br /> LEGAL for new construction: Short PlitfaubdIvision Lot No. (attach copy of long legal description) <br /> CONTACtiiilFORMATION 5314itkl <br /> OWNER NAME: TENANT NAME(If Commercial. <br /> OWNER.MAILING ADDRESS. STREET at,: Ave. <br /> CITY C STATE ) <br /> OWNER PHONE: 5115 9`70 512.2 OWNER EMAIL: <br /> CONTRACTOR NAME: oryl. ��,c1 <br /> CONTRACTOR ADDRESS: STREET 1-14 (roa <br /> CrrY6a� STATE ZIP! a ' <br /> CONTRACT R PHONE: <br /> .�� � COACI' Tfo3R 1: Af .�, # I� ► !" . '{� «.�1::�'' :,:. <br /> TRACTOR- CENSE tREO kt )P t _ s$ ,+ ITYDP evvRET TBOSINESS t ucENs UtRED) : Otalt ... <br /> PRIMARY CONTACT: ❑OWNER r CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ,425Z53 , <br /> TY <br /> CONTACT EMAIL <br /> } <br /> Extetang Use of Building: Contract Price of Work:.$ 1 D <br /> Proposed Use of Building Heat Source: Gas .,CElectric DOther <br /> Buiidleg Type: of(SFR-Detached ❑SFR Attached ❑Duple` 13Mpltl-F#rruly i of Unita: °Commercial ❑Industrial <br /> Type of Pip ct: ONew ❑Addition I:Remodel CIRepair DT.I. 13$i n ,❑S rinkter ❑Demolition ❑C hap ge of Use <br /> DESORtinION OF WORK: <br /> (a.ce.. has hat - K <br /> ASSOCIATED .BUILDING PERMIT#(i apptIcable), <br /> MECHANICAL PERMIT APPUCATION :R4� B RMI PPL[ A' [+1 , <br /> type of Project New Addn Alteration _Repair Type of Project _New _Adds Alteration .Repair <br /> #of <br /> List of EIxt e „ _ # A>; #of r Ffixfvrasr #of <br /> ..,_ � -`#Car'e�.•, Fixtures,, , <br /> NC—Air Handling Units— Heat`Pump • Toilet Backflow Preventer'(Inside Bldg), <br /> Forced Air Systems Unit Heater ' Bathtub Urinal <br /> Gas Piping 'Writer Lavatory(Wash Basin) Drinking <br /> eater Fountain <br /> Water H <br /> ,� "... RW _ �� ,Shower Floor Drain <br /> Gas Fireplace Stove 'Kitchen Sink&Disposal - Grease Trap <br /> Gas Range Dishwasher Roof Drains._,,;, <br /> r✓lothes Dryer Hookups, �; t?fflien, Clothes Washer Medical Gas <br /> Range Hood MWater Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other <br /> SPRINKLER ` <br /> KLEI��tSUPPRE$SI��� ''f'��`°�' <br /> Chemical or Water ' 4No.of Heads <br /> ACKNOWLEDGEMENT:!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,state,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 r 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 Atrly; <br /> z <br /> PUNA#� <br /> , .5.1 � 2 �. 01 <br /> Ovn <br /> r/Autherbgeg Ag Signature tl _. :' ' Date" <br />