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PERMIT APPLICATION <br /> OLT' BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (Pi 425-257-8810 I FAX 425-257-8857 1(E)evetettepsir everettwa.gov I www.everettwa.govipermits <br /> (Blueor Slack ink'Only Please) PR 3JEG T=SST It FG �JIA"T b <br /> PROJECT SITE S ADDRESS. 5 +i t <br /> /e ROPERTY TAX#. <br /> LEGAL for nein c ristruLllon: Short Plat,'sub;ivi ,t <br /> lo _� <br /> --.—Lot No.:, (attach copy of long legal description) l <br /> OWNER NAME: l Ai - <br /> � - * "` �� TENANT NAME(If CommercaJ); <br /> OWNER MAILING ADDRESS: STREET • <br /> ill "t.t.1 <br /> crti _� <br /> OWNER PHONE: t' � ' .,• sTnre \NA 71n �� <br /> Ara • lap OWNER EMAIL. � T <br /> CONTRACTOR NAME, Y\ “ 1 J�n C. <br /> CONTRACTOR ADDRESS: ; R.E V Y'a r v <br /> CONTRACTOR PHONE: STATE. A zin * ; 0 I <br /> c3 Q 0 0 CONTRACTOR t EMAIL' �t atr <br /> CO�r-T�,a�Ta�-I*��Ea�s����c>��R �:. .. �, � +N►' �.�II._+1 _ ..1t j,A !n a .Co <br /> CfTYC £'tEE E Yusiss LICENSE#(iEQ1J1RED): <br /> PRIMARY CONTACT: 0 OWNER 1 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> Doblo U2- <br /> CONTACT PHONE: Liczs 25Q c) 51) <br /> CONTACT EMAIL:de t-I 0 a e c_ k2� �i <br /> Bt71LC1lt G'PE IMI i`:Ai l?At�l -t i CD .. . ' <br /> ,1� <br /> cxistin Use of Building: -�� <br /> Contract Price of Work:$ - <br /> proposed Use of Bulleing - _...._ ____ <br /> l3uticiity. } Heat Source: `' ❑Electric ❑Other <br /> Type ofProject:e ■ i'-Detached ❑SFR-Atached ❑Duplex ❑Multi-l^am(fy- of nits`. <br /> T w ❑Addition °Remodel 1 eo3ir ❑LI. ❑Commercial ❑Industrial <br /> DESCRIPTION OF WORK: CISi;t� �Spr(rik(er f]Demotition ❑Chenge of Use <br /> aa-OUtt YC <br /> ASSOCIATED BUILDING PE, <br /> Rt491T#�(f applicable):MECHANICAL PERMIT AP,P'LICATiON ) <br /> Type of Project: New Addn Alteration ��`� ATIC�N <br /> - Repair <br /> of Type of Project: New Alteration Repair <br /> _Fir LISLOFixtures of <br /> FIgtUre5 L"s.f.zsf.Ftxturas #of <br /> —List_9f-r t�t€vrz�s-.— #of—Air Handling L'ni[5ixttrres Llfof-Fixture <br /> Fixtures <br /> -- --- <br /> Forced Air Systems 11111111111111111 Toilet L�ackflow Prevent sr o <br /> n <br /> si <br /> d <br /> e <br /> Br'd } <br /> M� Bathtub Urinal <br /> MNWater r Heater Lavatory(Wash Basin) Orinkin. Fountain <br /> am. n <br /> Gas Fireplace Refrigeration Shower <br /> Fteas Range Wood Stove Kitchen Sink&Disposal Grease <br /> eDTia <br /> Clothes Dryer Hookups Mmul Dishwasher Grease Trap <br /> Caohe,Hood Other: Clothes Washer Roof Drains <br /> MIN Exhaust Farr Water Heater Other Gas <br /> 11IIIIIIIIIIMIIIIIIIIISink Sen Ice/Bart iopietc.) Other <br /> 111111.11111111111111111111111111.1111 .11111111111 <br /> SPRINKLER]SUPPRESSION SYSTEM <br /> Chemical or Water <br /> MN 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 <br /> current federal,state,and local law. The granting of a permit only authorizes ap <br /> proved Official and <br /> begauthorized underany work and no deviations therefrom.Deviations must first be eulhonzed In'thing romythh <br /> and I comply with the State Contractors Law 15 circumstance.!am the owner,or l am authorized by the owner cf this properly to perform the work for which,a i' <br /> 27 Circ W and ce.l am eWw. <br /> C <br /> pP.lcallcn is made. <br /> City of Everett Official Use Ont:,- <br /> • <br /> :4+11 LQ ` PER T# <br /> Ow,era/Authvrized Age. Signature <br /> ' E C) <br /> ignature ' ` O� ' O <br /> cGeta tlevr ed 9/23/207 <br /> 81 <br />