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PERMIT APPLICATIO <br /> 00)111,,,t74. BUILDIN MECHANICAL/PLUMBING/SIGN/ PRJNKLER/DEMOLITION <br /> _ <br /> CITY OF EVERETT PERMIT SERVICES <br /> rT! 3200 CEDAR STREET,EVERE i t,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 {(E)everettepseeverettwa.gov I amwever !-govipemvRs <br /> /Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 1069. 7 19-`-11 / . U e t1 tete S .. .... !PROPERTY TAX If: <br /> LEGAL for newco uctton: Shat Plat/subdivision Lot No. (attach copy of long legal des an) <br /> CONTACT INFORMATION fir`/vW 1. & O&1)41S' <br /> OWNER NAME: TENANT NAME(If Commercial): FP d C rox -' cA 4-2 <br /> OWNER MAILING ADDRESS: sTREEr 9, i n K I U P 0.C I ri C S 4-. ,A.{114- U <br /> ary S ems.#4-1 ,e STATE Lf ZIP 4 g1 o z) <br /> OWNER PHONE: I ( ), C,)6 ) ('J ,OWNER EMAIL- <br /> CONTRACTOR NAME: l I llkA, I, _p P. 0 e fr\e tA-4 t C©ISS i- I/'M[+ ( <br /> (91" <br /> n� 1&-C- , <br /> CONTRACTOR ADDRESS: STREET . ( 9. 5 9$ V e el 3 i rcc b I v A 41- 5 2 3 <br /> CITY 1-00r).b"1 VI I STATE CA m, C//3 5 <br /> CONTRACTOR PHONE: R l g- 7y y- /1-7 3 !CONTRACTOR EMAIL: Do,yt 1 vt G eith.i 10%,e, ° - <br /> CONTRACTOR LICENSE#I(REQtnRED): M U rA /J E- VM\ 7 303 ICrnr OF EVERETT BUSINESS UCEICSE i-,-• - 5q- <br /> PRIMARY CONTACT: O OWNER XI CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1 <br /> 4)G11h4 6eJ(1� t1 <br /> CONTACT EMAIL: nc", 1 )G'e d 01 i t't k 09 v"t 0,' I- for i <br /> BUILDING PES APPLICATION 4 <br /> Existing Use of Building: Contract Price of Work$ fi C 6 14003 <br /> Proposed Use of Building: Heat Source: ^as DElectric DOther <br /> Building Type: OSFR-Detached OSFR-Attached ODuplex ©Multi-Family-#of Units: XICommercial Dlndustrial <br /> Type of Project ONew DAdcIlion °Remodel °Repair ,MT.l. OSign OSprinlder DDemotilion OChange of Use <br /> DESCRIPTION OF WORK: 0 Te Vl A Ir1 i ikAp V o o IM e A.4 -For Orfk U+ do I/1 1'c- O-F(is C e ., /600 t', <br /> ASSOCIATED BUILDING PERMIT U(if applicable): <br /> or <br /> MECHANICAL PERMIT APPLICATION/-- PLUMBING PERMITAIPPLICATION <br /> Type of Project New_ Addn ;.a •-. - Type of Project: New Adrift Aeration _Repair <br /> Md <br /> List of admits List ofFnchoes L"stofFixtures <br /> mes fFemmesRxfures <br /> NC-Air Handli U r" i Heat Pump I Toilet Backflow •:- (Inside Bldg) <br /> Forced ,,` - (/ Unit Heater Bathtub Urinal <br /> s Pining ' Boiler Lavatory(Wash Basin) b i•",„ , Fountain <br /> -, Refrigeration Shower 1 Floc Drain <br /> Gas Fre• -.- Wood Stove Kitchen Sink&D" 'tz Grease Trap <br /> 10 Ducting Dishwasher / Roof Drains <br /> i. -� Dryer Hookups Other .. Clothes V Q Medical Gas <br /> --nge Hood I Water HeaterV ti Other PEA/1-F& C hrkkit42 <br /> I Exhaust Fan A Sink(Servi• 4:-rlMop/etc) Other: <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> {Chemical arVilr I "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.f am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and!comply wffh the State Contractors La - and 296.200A WAC. <br /> City of Everett Official Use 04( <br /> ,- � /S PERMIT Igo t " 0 V <br /> Owner/Autho ".Agent gnature Date (Revised 9)23/2016) <br /> (11 1 <br />