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PERMIT APPLICATIOI'I <br /> BUILDING/ MECHANICAL/PLUMBING/SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 I(E)everetteps+meverettwa;gov I www,everettwa.gov/permits <br /> (Blue or Blank Ink On! Please) PROJECT TE INFO,liktION, <br /> PROJECT SITE ADDRESS: I ikek Loni PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Let No. (attach copy of long legal description) <br /> CONTACT IN1O#M,t 11014 <br /> OWNER NAME: Cirtil <br /> r'' �-- <br /> ikt TENANT NAME(If Commercial): <br /> OWNER MAILING ADORES R: __. MEET '1 <br /> .,. _. CIrY ` STATE ZIP L!2D <br /> OWNER PHONE: „ <br /> ., • r . � A OWNER EMAIL: <br /> CONTRACTOR NAME: OM tieA <br /> CONTRACTOR ADDRESS: STREET iLitC . <br /> act <br /> STATE zir ? 1.... <br /> CONTRACTOR PHONE:115 .59 05-- (,) CONTRACTOR EMAIL: d-�° 01®y t -er'1.i' CO <br /> rel <br /> CONTRACTOR LICENSE#REQUIRED):CfrlYttet.. YS 74 r CITY OF EVERETT BUSINESS LICENSE i#(REQUIRED): 1(.0C/303 <br /> PRIMARY CONTACT: 0 OWNER ( CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: 4 CONTACT PHONE: <br /> 015 ,��``CONTACT EMAIL: r t0 r i <br /> }may ■_ �yy y �y t � crr� �1 ;� <br /> BIU1'IL Ot�N P Sjui yP <br /> Q <br /> a - <br /> Existing Use of Builds .: Contract Price of Work.$ +# <br /> Proposed Use of Building: Heat Source: %Cas 0Electric Othh . _ <br /> Building Type; XSFR-Detached DSFR-Attached QIuplax ❑Multi-Family of Units: ❑Commercial ❑industrial <br /> Type.of Project: GINew ❑Addition ❑Remodel CRepatr DTI. D ign OSprinkler ❑Demolition .ElChange,of Use <br /> DESCRIPTION OF WORK: - - <br /> lnS1' -r lcu.f2.. <br /> ASSOCIATED BUILDING PERMIT# if ajmiicabie <br /> ,, <br /> MECHANICAL PERMIT AP;PLICATIo a PLUMPING'PER/4111-APPLICATION APPLICATION - <br /> Type of Project: New — Addn _Alteration _Repair Type of Project: New Addn _Alteration _Repair <br /> Fixtures • <br /> List of Fixtures Fixtures Llst of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> A/C—`Air Handling Units Heat Pum pToilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems .` Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration vShower .Floor Drain <br /> f <br /> Gas Fireplace Wood Stove Kitchen Sink&Oieptrsal — _Grease Trap <br /> Gas Rerige Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater _Other: <br /> Exhaust Fart Sink(i+rvi tiBarlMoptettc. Other: <br /> SPRINKLER I Sit SUPPRESSION SYST . <br /> Chemical or Water .No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.i4iric 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.I am the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Cityof Everett Official Use Only ._ <br /> tb.10.I'j PERM1()�Tj n �� Q(v�� <br /> d ff <br /> Owns/Authorized Agen• gnature � Date rRa�Psif4164i <br />