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PERMIT APPLICATION <br /> (0"*-77- BUILDING / MECHANICAL/PLUMBING/SIGN I SPRINKLER/ 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)eve„tteps{dsverettwa.gov I www.everettwa gov/permits <br /> (Blue or Bleck Ink'Only Please) • 'PROJECT.SITE INFikMAtioN •` e ;,` <br /> PROJECT SITE ADDRESS. IO 21 <t.> / ,r / .F, 1PROPERTY , <br /> TAX t#: <br /> LEGAL for new cont action. Shore Platl,up ti.�=snTer <br /> W — LW.N .__ (attach copy of long legal description) <br /> CONTACT INFORMATION ' ' <br /> OWNER NAME: ' <br /> ""'" r/ TENANT NAME 'If Commercial): <br /> OWNER MAILING ADDRESS'; ._«. jaw p <br /> ` I <br /> ;ar, . ,, t ,/ <br /> OWNER PHONE: -2 'rfh/ <br /> OWNER EMAIL: <br /> In CONTRACTOR NAME: *I art C <br /> CONTRACTOR ADDRESS: ^si"BEET 1� ° ,,,g(..A.�, , <br /> iJ(J' <br /> ciry __ I ,„tt1✓ ! <br /> STATE A 77-IP dr <br /> CONTRACTOR PHONE: 2 Ct 0 0 CONTRACTOR EMAIL.,0 <br /> T-FtA�-�w�-trr�NsE- s .e 4 � 111' AA ! 411 �f(l� ,r�© <br /> '(REQUfRE jt _ fes,:,-.-*-40° <br /> PRIMARY CONTACT: 0 OWNER IYCONTRACTOR 0 OTHER(Please Specify) A <br /> CONTACT NAME: <br /> T <br /> Mbio1/ CONTACT PHONE: '42S' ZSL? Oer <br /> 'LL <br /> CONTACT EMAIL: r f .1 / <br /> ..�j! L Item 0 . <br /> JRUILDiNG PERMITI,>> P-, s '1"roo , - <br /> Existln* Use of Buridtn .- �� <br /> Contract Price of Work:S 41' b Q <br /> Proposed Use of Bulldin • -- <br /> Heat Source: "no,as ❑Electric ❑Other <br /> a ' -Detached l�SFR-Ar <br /> SFR-Attach-ed OD lex .. <br /> tip ❑Multi-Farstlly,�of Units ❑Commercial ❑Industrial <br /> Type of Proje,Wt: ❑New ❑Addition ❑Rsmodsl ❑Reesir ❑T.I. 03( n ❑Sorinkler ❑Demolition ❑Chen a of Use <br /> DESCRIPTION OF WORK: <br /> 11- ,c,,p(aL62-- qo<50,( 1 o 4 'IC* bah wceie- -k-ct,".k. ci4 b ctse.t,ve nt- <br /> ASSOCIATED BUILDING PERMIT 0'if apoficaErle): <br /> MECHANIG4CPE tMIT AP.PI.ICAT1ON <br /> W,PtutvlBiNG3#tEFiMlttttNicArIory <br /> 11f Type of Project: New Addn Alteration <br /> . rsLof F'Ixtu£ac _Repair <br /> T t r??s . #of — -t 1st al FtYtitres ft of <br /> �A/C`-Air Handlin Units Jxturas Fixtures--� °f -- <br /> Forced Air Handl <br /> ms Heat PiJJnp Toilet <br /> illElIIIIIIIII ��� Bathtub <br /> Backflow Precentor Inside Bldc) <br /> Gas Piping Urinal <br /> Water Heater Boller <br /> Lavatory(Wash Basin <br /> )allill �Refrigeration Floor Fountain <br /> 1111111111 Gas FireplaceMIR Shower Floor Drain <br /> Ilaill Gas RaepIIIIIIIIII Wood Stove Kitchen Sink&Disposal <br /> Clothes 0 Ducting Dishwasher Grease Drains <br /> er Hookups Other: <br /> Roof <br /> Ran.e Hoed1111.1111111111111111111111. Clothes Washer <br /> Water Heater Medical Gas <br /> MIN���. Sink Senfice/bar/Maple#c, Other: <br /> Other: <br /> NIMINMIIIIIIIIIIIIIII <br /> SP,RtNKI.ERi'ISUPPRESS[ON SYSTEM <br /> 111111Q PI <br /> - - ullin No.cf 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 /> must <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom.Deviations must fist be authorized in wntfn <br /> Building Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for whichappUg from the with <br /> is+rade <br /> and J comply with the State Contractors Law 18.27 ROW and 296.200A WA<:. <br /> (Z t City of Everett Official Use Only <br /> Gwh rfAuthcri l A e A...`•. • j Q/� — 02_ <br /> S SPgnature <br /> Gate • (Revised 5/23,21)1 6) <br />