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P <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL!PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX425- 5--8857 RE)everetteps@everettwa.gov I Ynfweverettwa:govtpelmifs <br /> -.): Bkle or Black kik ly Please PROJECT SITE INFORMATION' SITE ADDRESS: 3 1 <br /> PROJECT S T . .:��{�- �S"��c ve.. lid. PROPERTY TAX <br /> , LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> . . . - . - ' ..GONIA r.ikPOlimATfoN - • • . • . . <br /> OWNER NAME: ."f-f- � TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRES§e sraesr 5 l i t-I S-re1.Avt, (A). <br /> CITY ‹„ ,. 't"r STATE " ZIP 1 6 o 3 <br /> OWNER PHONE 42S .- . s" 49 3 OWNER EMAIL: €.'Oci <br /> l,eqt_ ,�lcr.k00. (ore, <br /> CONTRACTOR.NAME; E tVaz..G "ci: 1 ( }Jk'G A-t <br /> CONTRACTOR ADDRESS: srr asr '2I 2-0 `CAc.t pie_ AU gr <br /> circ (.16.P.4511 STATE (A./.14.- zip ii S2ey <br /> CONTRACTOR PHONE: 4 s5-2.52.''j///4 • 1coNTRACTOR EMAIL <br /> CONTRACTOR LICENSE#(REQUIRED): tviu2.6.55 ca .r - ICiTY OF EVERETT SUS-MESS LICENSE#(REQUIRED) /a b' ``,*3' <br /> PRIMARY CONTACT: 0 OWNER 1ICONTRACTOR 0 OTHER(Please.Specifyj r <br /> CONTACT :1441 <br /> CO1/TACT PHONE: q 2 5- 2-5-2-,ti <br /> Ca CONTACT EMAIL: w <br /> ' BUILDING PERMIT APPLICAtIOi! , ' <br /> Existing Use of Building: i Contract Price•of Work:$ %, 1. <br /> Proposed Use of Building: Heal Source: Lias LDEtectric DOther <br /> Building Type: NISFR-Detached DSFR-Attached ODuPlex 0Multi-Famity €of Units: LiCommemial C(lndustrial <br /> • <br /> Type of Project: DNew LlAddltlon DRemodel EIRepair f.1, LlSign DSprinkler l jDemolition ElChange of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# ifa•pllcabie':: <br /> " .IIt1 CSANICJU.OtiteiMITAPPLIGATIciioi • - PLUMit-HG PERMIT APPLICATION - <br /> Type of Project: New Addn _Alteration Repair Type of Project: ,New Addn Alteration Repair <br /> #of List of Fixtures #of List Of Fixtures # List of Fixtures '-of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AUG Alr Handling Units Heat I�ttmp 7 Siler Baekilow Preyenter(Inside Bldg) <br /> I,. Forced Air Systems Unit Heater Bathtub Urinal: <br /> Gas Pipincg Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration ration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> RangeHood' Water Heater Other: <br /> Exhaust Fart Sink( civ ceJBar/Mopletc) Other. <br /> ,..SPRINKLER/SVPPRE SIPN SY TEllii1 <br /> (Number of Reads <br /> ACKNOWLEDGEMENT:I have reviewed th' .,./cation> d confirm the information cootehedherein is tare ornfcotroct.Kiwi(done pursuant to this permitmust comply <br /> current federal,state,a d local law.T -'ranting ofe pe It only authorizes approved work and no deviettons#herefrom.Deviations must first be authorized in writing from the <br /> Building Cfficial'=fore'•eing autho ed underany cir instance.I am then wnet,or I am atifha izedby the ownerof this property to perform the work forwhich application is made, <br /> and!comply w the late Coo .ctbrsLaw 1827 Wand29f2(10AWAP' <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Au orae.Agent Sign•rDat (Revised 612,, 0it) <br />