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PERMIT APPLICATION <br /> , ,; BUILDING/ MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> e CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 M(E)everetteps@everettwa.gov 1 wwweverottodavovipamitts <br /> (Blue'If BakInktOnl P ,PR sill.._ E <br /> , ` ' ' <br /> V <br /> PROJECT SITE ADDRESS: 2 5 . / PROPERTY TAX#: <br /> LEGAL,for new construction: Short Plat/subdivision Lot No.* (attach copy of long legal description) <br /> �� ON Act INFO MllA"''l tlx: � A € <br /> � <br /> ` by . <br /> OWNER NAME ... <br /> ,. r-�� �s 1 . .m TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 44` e + `,�,.f� <br /> Cn' r F 96� 3TATE,,,:LJV r.l. ZIP. AD <br /> OWNER:PHONE: f 2(o 2."6" OWNER,EMAIL: <br /> CONTRACTOR NAME: cm n in c <br /> CONTRACTOR ADDRESS: STREET 14, r <br /> CITY i STATE Wrt- ZIP g20 <br /> CONTRACTOR PHONE. 2.5 zettlaC7450 CONTRACTOR EMAIL. <br /> CONTRACTOR LICENSE#(2EQUIRF ejvi 'pit 3 + ;CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) cgoqg <br /> PRIMARY CONTACT: 0 OWNER NeCONTIRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:T, <br /> CONTACT!/�it~J�V CCONTACTPHONE: � e 253I �mI0 <br /> CONTACT EMAIL a e , wa <br /> Y' BUILDl ottiitRMlfAPIiIaTIOt1 -, .; '"-l1 <br /> Existing,Use of Buildings Contract Price of Work:$ #`0 <br /> Pfoloased Use of Building: Heat Source: ❑Gas Xclectrtt ❑Other <br /> Building Type.. ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Mull*Panlily of Units; mercial ❑Industrial <br /> Type=of Project ONew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign OSprinkter ❑Demolition Cil hartge of Use <br /> DEStRIPTION`OF WORK: <br /> Ins - 11.,c <br /> ASSOCIATED BUILDING PERMIT#Of applicable): . <br /> MECHANICAL PERMIT APPLICATION T .?. ./1.','-''''.'-'... PLUMB11t1q PERMI1 PPGIGATION <br /> Te <br /> yp of Project: '_New Addn Alteration <br /> —Repair ' Type of Project: New Addn _Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #°f List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> I AIC-Air Handling Units Heat Pump ;"; ' .Toilet Backflow Preventer(Inside Bldg) <br /> ,Forced Air Systems Unit Heater Bathtub Urinal <br /> 'Gas Piping <br /> p g Boiler Lavatory(Wash Basin) Drinking Fountain . <br /> Water Heater' Refrigeration 'Shower 'Floor Drain <br /> Gas Fireplace `Wood Stove: Kitchen Sink 4 Disposal ,Grease Trap <br /> Gas Range �buctin�q Dishwasher Roof Drains' <br /> Clothes Dryer Hookups Other Clothes Washer Medical Gas: <br /> Ran a Hood <br /> g- Water Heater Other: <br /> Exhaust Fan <br /> Sink'(SerYie+aYlt'JMopP .) Other <br /> SP INKLERaSUPPRESSION SYSTEM'' x <br /> Chemical.or Water I INo.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 taw.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!am authorized by the owner of this properly to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> OW of Everett Official Use Only <br /> .,..., , <br /> [0•a . PERMIT <br /> Ow eriAuthortzodAg S19nature Date a <br /> fi2au+'satilirj/2096j <br />