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„— PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> iwil CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (Pi 425-257-8810 J FAX 425-257-8857 I(E)everettepsOeverettwa.gov I www.everettwa.govlpermits <br /> (Blue t►r Blank Ink Only Please) - 'PRQJECT SITE1INFORMA`f1ON <br /> PROJECT SITE ADDRESS: 12,2 (:::P i e.> SE —tFkt <br /> ” <br /> LEGAL for new construction: Short PlatfsUbdivislon PROPERTY TAX#; <br /> — -.- Lot No. (attach copy of long legal description) <br /> ACO <br /> OWNER NAME: ONTACT,INFO NM TI (ifON „ I <br /> •'bI: C4 _, r +iaFrit( Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 223p igill 11, f-y <br /> c,TY er �j '? 13 <br /> STATE ZIP <br /> OWNER PHONE: g2.5 q31. 4/427 OWNER EMAIL: <br /> CONTRACTOR NAME. . ' in <br /> In C <br /> CONTRACTOR ADDRESS: sinEErr 'I L�.(� p j- oct, u <br /> ,...........w--» ._.» <br /> CITY N'-^. 1 MC.T.�'1.�✓1., SLATE ` yj - ZIP 4.i? �✓ 1 �. <br /> CONTRACTOR PHONE: L. J <br /> 60 CONTRACTOR EMAIL..?Ap4 1 _I4 .,.s_ fiat .coryi <br /> CONTRACTOR-LICENSE#(REQUIRE9):C.:,— aN p <br /> - -CITY OF EVERET.BUSINESS LICENSE#(REQUIRED)r- IOtact <br /> PRIMARY CONTACT: U OWNER L /CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> -Dobb C^ CONTACT PHONE: 1 .25 2.5c7 (:) 57) <br /> �iKN'J CONTACT EMAIL: ✓t 1„a °j C`l keGL CO <br /> ril <br /> 'BU1LDING;PERMITAPPIICATlOte .•' -.,;'P. <br /> Existing Use of Building; <br /> Contract Price of Work:S JO,OOC1.Q <br /> Proposed Use of Building: <br /> Heat Source: "as ❑Electric?€ ❑Other <br /> Dufiding Type: SFR.Detaohed ❑SFR-Attached ❑Du r1 x DMulfii-F mil of Units: — <br /> Tytpe ofproj�c;:lpNe,,v ❑gddition 'y .�,.•,._�. ❑Commercial ❑industrial <br /> IRemodel ORe air 07,1. USign )Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION! OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL=PERMIT APPLICATION ' .F. :, <br /> Type of Project New Addn �" •�1MElING I�IrRMIT i'J>i +P!C(CQ1'IOIV <br /> Alteration _Repair <br /> it of Type of Protect: ew `gddn Alteration TRepalr <br /> - #of of <br /> — #ofEsixtanys — GSxIrs _ -.— FikfUrs Listof-Fxture — Flxfures List oI Rxfor s <br /> Llsr of Fixtures- <br /> Fixtures — — <br /> 111.01 A/C–Air Handling Units <br /> y 1 Heat Pune{, <br /> Minn Forced Air Systems Toilet Backf{av��Preventer inside Bldg) <br /> MN Unit Heater Bathtub <br /> Gas Piping Boiler Ur[na! <br /> ShowLavae Wash Basin) Drinkin <br /> illIllr Refrfgeratir,n Sha�.var g Fountain <br /> Wood StoveFloor Drain <br /> Mill . Kitchen Sink 8,.( --------di-is oral ease Trap <br /> ��OtheInc Oishw�aher <br /> Clotftes Ors/e?Hookups Other: Roof Drains <br /> MEMRan.e Hood Clothes w,er Medical Gas <br /> _afar Healer Other: ' --------- <br /> Sink ServlcefBat7Mcp{etc. {?the?; <br /> 111111111.111 ,IIIIIIIMI <br /> ” SPRINKLER''(SUPPRESSION SYSTEM <br /> INMMIChemical or Water No.of Heads <br /> ACKNOWLEDGEMENT.•I have reviewed this application and confirm the Information contained herein is true end correct.Work done pursuant to this permit must comply <br /> current federal,stale,and focal law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing <br /> Building Oficial before being authorized unaer any circumstance.1 am(he owner,or I am authorized by the owner of this property to perform the work for which application <br /> the <br /> nyihe <br /> sl made, <br /> fr <br /> and!comply with the State Contractors Law 76.27 ROW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> rr�,A (Q PERMIT# <br /> Owor/Authorized A a r a.l �' '� A� 11. 10(i —? �j� <br /> 8 signature Datel✓ <br /> (Revised 5t23/2016) <br />