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0100. <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL/PLUMBING l SIGN/SPRINKLER/DEMOLITION <br /> 00140' s s CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P')425-257-8810 I FAX 425-257-8857,I(E)everatte <br /> (B art lack,1 ON'xi P1 s +rere� uv I www euaretiw ir#faei flits <br /> PROJECT SITE ADDRESS: t, A <br /> I fl 1 t PROPERTY TAX#: <br /> LEGAL for new construction Short Plat/subdivision <br /> yap y.■ Laigo. (attach copy of long legal description) <br /> .WN ,r,w..e....W...r......r; i NTAC 1 itiFO�rtiik l '� t.- .�.: <br /> E#�NAME. <br /> � : I TENANT NAME(If Co ttmerciat). <br /> OWNER MAILING ADDRESS: <br /> STREET 2 1.. <br /> "" STATE r" 3 ZIPSZD I <br /> OWNER PHONE: ' � 2.' Z OC)ZO <br /> OWNER EIVIAIL <br /> CONTRACTOR NAME; n , <br /> CONTRACTOR ADDRESS: sTREET 1 t-i.. <br /> ia , <br /> n CnY�� Lr4 STATE ZIP,R 2c)1 <br /> CONTRACTOR PHONE; a ( CONTRACTOR EMAIL <br /> 'I�i "�',1 °#(f 1r 1t�7.• 1:1111 . 1"4"QP I:i tET raUSIN S3"tu CEN E tt as F <br /> PRIMARY CONTACT: 13 OWNER �r✓ONTRACTOR 0OTHER(Please Specify) <br /> CONTACT NAME;' <br /> CONTACT PHONE: <br /> De-fato Lk- <br /> CONTACT EMAIL. <br /> ......... t , amu,- BUILD 3 OffttflOt , �. <br /> Esistirt. Use of Build <br /> Contract Price of Work:. Q " <br /> Pro'•,,ed Use of Builds .; <br /> Heat Source +t Gas ❑Electric ❑Other <br /> Sundt:+I,pa. ! FR.Detached OSi'RAltached CIO ilex OMuiti-Famit 4 of Units: <br /> ❑Commercial Olndustrlal <br /> I .a of Pro Oct! ❑New CiAddition ❑Remodel C]Reiair 07,1. ❑S-•tt 13 '• nklee ❑Demolition ❑Chan.a of Use <br /> DESCRIPTION OF WORK: <br /> l 5 as rte. .c..:2, <br /> ASSOCIATED BUILDING PERMIT# ifa:Plfcabis},,•,., <br /> MECHANICAL OE 4 MIT A P*L1cA'T.lbll+1 k lrq £ _ <br /> i > 14I E <br /> 1.........77,...!...____.......___.___ypb orotect —New Addn Alteration Repalr t 'l:-ICA 1`IQN ' <br /> #of Type of Project: New Addn Alteration Repair <br /> #a>r <br /> --ft <br /> -ft •, ; pixrures,--41SC040 xfttika #of #of <br /> AIC–Air Heift. Unita Heat <br /> Fixtures or` flrturPt: <br /> Heat Pump <br /> Forced Air$ stems Backflow Preventer in c h.Bid! <br /> tfrtlt;Hee er` <br /> Gas Pi.inx Bathtub � � Uri tit <br /> Wates heater zit Lay* Wash Basin Drinks • Fountain <br /> Saeer ea er Refri•e tion,: Sir <br /> Wood Stove Ftoor tJi <br /> ast an.a �e.Sink&Dies el Greaser]f. <br /> iJucling DishwasherCIothesDrot { <br /> Roof brains <br /> s: kpth3r; Clothes Asher Medic'al GasRanseHmeJvveterH tetother:Fan <br /> Exhau <br /> irt7tSandal/Bar/M..etc Other; <br /> SPRINKLER iSUIPpRI I.;8 'i1ON$`YSTBM ,., ,.;,: <br /> Chemic l 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,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 I am authorized by the owner of this property to perform the work for which application is made, <br /> end!comply with the State Contractors Law 18.27 RCW and 298.200A WAC. <br /> rfty of Everett Official Use Only <br /> „i>ll{ <br /> 12-,, <br /> eriAutit et It t3a <br /> hortzed,Age Signature te i ,+ <br /> PER \ 2 <br /> — de �_._ <br /> , ( a.Wsed.9123/2015) <br />