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PERMIT APPLICATIOI <br /> BUILDING/MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> ,,�V/'''� CITY OF EVERETT PERMIT SERVICES <br /> . - <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 iwmtevefettNa.govipermtis <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECTTSITE ADDRESS: 10 6 2 7 M.+11 ,/` . de itme S ti; PROPERTY TAX#: <br /> LEGAL for newconstruction: Short Platisul d-d+ision Lot No_ (attach copy of tong legal descriplion) <br /> CONTACT INFORMATION s571/,../G4&., eifl'd{,c S <br /> OWNER NAME: TENANT NAME(If Commercial): F p A c v 1-K r A }- <br /> OWNER MAILING ADDRESS: STREET g f) N P&C I rf C J Jr.. ,,,y0:4- ,..(,)--5 <br /> CITY 5 ecktti e STATE L f A ZIP 9 g 1 ® 3 <br /> OWNER PHONE: I ( )06 ) -300 r 6S OWNER EMAIL: <br /> CONTRACTOR NAME: t vA _ <br /> CONTRACTOR ADDRESS: STREET , <br /> -. L - .- ) r ./ <br /> - - .. s <br /> CITY , _ STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: — , <br /> CONTRACTOR LICENSE QUIRED); M (1 M 0 E V/"\ S 7 30-c CflY OF: REIT BUSINESS #LICENSERECti <br /> PRIMARY CONTACT: 0 OWNER giCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: t 1 CONTACT PHONE: f t - 7 f-L t - I y-2 3 <br /> 11' L C/L l( e,' • CONTACT EMAIL: J G"�11i� eo 1,-1�'• I- r-a yet <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work$ I `Q©C) _ <br /> Proposed Use of Building: Heat Source: Gas ❑Ele 'c ❑ <br /> Building Type: ❑SFR-Detached QSFR-Attached ❑Duplex ❑Multi-Family4ofUnits:T_ JZCommercral Qlndustrial <br /> Type of Project IJNew °Addition ❑Remodel ❑Repair , T.I. OSiign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 9 Te in.Gk 11-' i imp 'o 0 w e A.4 -Por Ort 1 u cl o iii.4r 1‘C &('c-I'(le , / r <br /> %`^eC.lG.yC1 c,00 co y' T <br /> 1 _ \%0Lk — �3� <br /> ASSOCIATED RILING I-t ,. \dn�l ._ <br /> MECHANICAL PERMIT APPLICATION Drk 4RERillflt APPLICATION' <br /> Type of Project New_ Addn Alteration Repair T Project- ( New Addn Alteration _Repai <br /> #of List of fixtures #of List of Factures #of List of Fixtures #of List ,.,; -- <br /> Rxtures Fixtures<# Fixtures Fixtures <br /> NC Air Handling Units Heat Pump` I To -t Backtlo 'reventer(Inside Bldg) <br /> Forced Air Systems Unit Healer Bath ,• Un.,s <br /> Gas Piping Boiler. Lavatory . -sh Basin) : ::.Fountain <br /> Water Heater Refrigeration Shower Roar Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& s' poral Grease Trap <br /> Gas Range I d Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: - ClothesWasherMedical Gas <br /> Range Hood Water Heater Li Other: Pe;n-rn9.1 (''hM'r_e.i <br /> I Exhaust Fan f; Sink(Servi r- ar/Mopletc.) Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 'Chemical or Water 1 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 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 tern the owner,ort am authorized by the owner of this property to perform the work for which application is made, <br /> ands comply with the State Contractors La &2 R nd 296.200A WAC. <br /> City of Everett Official Use Only <br /> ,„ . / J V// ‘/ /g PERMIT-#,� So_ 0‘11_ <br /> OS(17 <br /> Owner/AutloYnd Agent ignature Date (Revised 9/23/2016) <br /> 1:?) <br />