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PERMIT APPLICATI&H <br /> , BUILDING 1 MECHANICAL I PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ,44 .W.".iv 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 1(E)evenaftepsti)everettwa.gov I VAvwevereitwa.govipemits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2 111 Co/9y /94--e- PROPERTY TAX ft: <br /> LEGAL for new construction: Short Plat/subdivision Lot No._ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: A19.574L)by ,,,e05:59,0 jit,02/ / TENANT NAME(If Commercial): <br /> OWNER MUM ADDRESS: STREET //103 422 /2 1 ,5 Z--: <br /> EXIT E V E.R E TT STATE k/104 ZIP g 43 2 08 <br /> OWNER PHONE: 192 S — 7 3 7 — 0 0-?.5" OWNER EMAIL: thrn ox 03 7-427y.iI4c2c.. c,6vti <br /> CONTRACTOR HAM i& OW%&L4' <br /> CONTRACTOR ADDRESS: STREET <br /> CRY STATE ZIP <br /> -- <br /> CONTRACTOR PHONE: _........) CONTRACTOR EMAIL: <br /> CONTRACTOR UCENSE 10(RECtui--4 i): CITY OF EVERETT BUSINESS LICENSE ARE• 44111111111P.' ' <br /> PRIMARY CONTACT: 0 OWNE- e 4..vu' —CTOR 0 OTHER(Please Spedfy) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> BUILDING PERMIT APPLICATION ' <br /> Existing Use of Building: Contract Price of WoICS *--0 C3V . <br /> Proposed Use of Building: Heat Source: NGas OBectric CRNfier , <br /> Building Type: OSFR-Detached OSFR-Attached °Duplex OMulti-Family-ft of Units: ISICommercial °Industrial <br /> Type of ProjectjSktklew °Addition CIRenodel °Repair OT.I. °Sign OSprinIder °Demolition °Change of Use <br /> DESCRIPTION OF WORK: <br /> rotkoA IA/ phtb16101/61 Ole/91N 6y-52-&-A-1 --/Co c >- i <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project _New _ Addn _Alteration _Repair Type of Project: New Addn Alteration _Rept& <br /> *of *of *of *of <br /> List of Rxtures <br /> Fbaures Mimes List of Rxtures List of Fixtures List of Fixtures <br /> Rxtures Fixtures <br /> .4 NC-Air Handling Units Heat Pump 4' ,Toilet 4 &sallow Preventer(Inside BIdg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> i Gas PION; Boiler q Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower 4 Roar Drain <br /> Gas Fireplace Wood Stove 3 Kitchen Sink&Disposal 4 Grease Trap <br /> Gas Range DuctingDishwasher Roof Drains <br /> 4 Clothes Dryer Hookups Other 4 Clothes Washer Medical Gas <br /> Range Hood Water Heater Other <br /> Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> !Chemical or Water I INo.of Heads <br /> ACKNOWLEDGEMENT:1 have reviewed this apkation and confirm the information contained herein is true and coned.Work done pursuant to this pears*must comply with <br /> current federal,state,and local kw The granting of a perm&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.I am the owner,art am authorized by the owner of this property to perform the work for w*ich application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> .,._ <br /> ate PFJ,(1q09—0 0 Co <br /> (Avner/Authorized Agent Signatureq (Revised 9/23/2016) <br />