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PERMIT APPLICATION <br /> 04147-1- BUILDING / MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 I(E)everettcpsczeverettwa_gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE'INFORMAT�ION <br /> PROJECT SITE ADDRESS: 1 ,) i , E <br /> 4 <br /> LEGAL for new construction: Short Plat/subdivision PROPERTY TAX#: <br /> Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r' ", <br /> " S.7 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET J /3114 71- ..".---0'�} <br /> CITY .r /....0 A , f ,� -'` <br /> - STATEZIP <br /> OWNER'PHONE: A 5 }' OWNER EMAIL: <br /> CONTRACTOR NAME: Dr 140AI n tl,.l c_ <br /> CONTRACTOR ADDRESS: STREET 11' <br /> CITY <br /> � STATE >t `A- ZIP (1g0 <br /> CONTRACTOR PHONE: 1425 Z'3 cl, 0550 (CONTRACTOR EMAILi <br /> .CONTRACTOR LICENSE#(REQUIRED): t‘.9 � •coal <br /> C4 } J.- oct R-4- ICt`rY otrEVERET-BUSINESS LICENSE#(REQUIRE ): 0 jp 9.g <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: L,� .2.6 2.5c/ ID � <br /> ,- <br /> De,bto Le, <br /> CONTACT EMAIL: -ln t,.�t,..0j elcis 4✓t5 ,CO <br /> rvi <br /> - BUILDING PERMIT APPLICATION ' ' 1 <br /> Existing Use of Building: Contract Price of Work:$,,, <br /> Proposed Use of Building: — <br /> ,Heat Source: ?s ❑Electric ❑Other <br /> Building Type: FR-Detached DSFR-Attached DDuplex DMulti-Famii .#of Units: trial <br /> Y ❑Commercial ❑Industrial <br /> Type of Project: DDw ❑Addition ❑Remodel ❑Repair DT.I. DSign DSprinkler ❑Demolition ©Change of Use <br /> DESCRIPTION OF WORK: <br /> kteace_ ► j rvt.Q oZ <br /> ii <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION <br /> PLUMBING PERMITAFlPaATION , <br /> Type of Project: New Addn _Alteration Repair <br /> #of Type of Project: New Addn Alteration _Repair <br /> tsf.szLFlxfurrs __ _ #of #of <br /> Fixtures-- FiXfures--- ofEixtures--.—_ Llatol-Fixtures ...__._. #of <br /> F <br /> F7xfures List of Fixtures <br /> AIC—Air Handling Units Heat Pum Fixtures <br /> j Forced Air Systems p Toilet Backflow Preventer(inside Bldg) <br /> Unit Heater Bathtub Urinal <br /> Gas Piping Goiter <br /> Water Heater Lavatory(Wash Basin) Drinking Fountain <br /> Refrigeration Shower <br /> Wood Stave Kit <br /> Gas Fireplace WFloor Drain <br /> Gas Rangechen Sink&Disposal Grease Trap <br /> Ducting Dishwasher <br /> Clothes 0 er Hookups Other: Rediat Drains <br /> Clot_Rari e Hood Clothes Washer Medical Gas <br /> Exhaust Fan Water Heater Other <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER>'F SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> - <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,slate,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 /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ' ^ --^� -i7 <br /> PER ('\y/��j\ ` 3 <br /> Ow,er/AuthdrIzed Age Signature Date <br /> (Revised 9/231201N <br />