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BUILDING 1 MECHANICALS PLUMBING I SIGN IN <br /> SPRINKLER 1 DEMOLITION <br /> #111".74 <br /> 40IWCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I sE)sveretteas(•everdttwe.gov I awvw.everettwa.gov/permits <br /> (Blue or Black Ink Only` Please <br /> ) PROJECT BITE INIFORIVIA =T � y?ON4 �,._ _ __ <br /> PROJECT SITE ADDRESS: <br /> _._ Ii +...4I) ii,ji PROPERTY TAX ft: <br /> LEGAL for new con>truc__ Short?;a..... div 50-i_ <br /> -- _ Lot No. (attach copy of long legal description) <br /> CONTACT_tNFOI IItI I'IC N <br /> OWNER NAME: ..4M 0a, iii <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDR' SS: STR7„- Sea ur <br /> l <br /> - STATE y <br /> OWNER PHONE: 11 lb. 5 +� � <br /> �+ ' ♦14. 01156 OWNER EMAIL: <br /> CONTRACTOR NAME: s in 1f1 <br /> CONTRACTOR ADDRESS: STREET t � OC.CpXdi <br /> clrY ,i > , y, <br /> STATE Vj t - ',, g g 2 0 j <br /> CONTRACTOR PHONE: t'� 5o CONTRACTOR� Q Qt <br /> EMAIL..i `. # �, "tn Ai. wf.r—rig a `COIY , <br /> _ –+:OAITRA&Tt31i-{�ICEPtSE CONTRACTOR -- _ <br /> " r*,-C I <br /> -� Lf T y°JP1tLR£T1`BtJSYNESSt1Gc*ISERctIt7TRE0); l } q7 <br /> PRIMARY CONTACT: Q OtryNERf?NTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME _--_ <br /> �"'��'^c,., CONTACT PHONE: 4.25 25�j 0550O5 � <br /> Leo CONTACT EMAIL: <br /> apjak2o'C J .Ccsni <br /> ugllilaOlNG=r?ERIVIl1' AP#LI04'rloNtM <br /> Ex€sting Use of Bultdin <br /> Contract Price of Work:$ [' <br /> Proposed Use of Btalldi-� : ___ <br /> Heat Source: r,1 G QElectric QOther <br /> Buiiding Type: r R-Detachad ❑SFR-Attached C]Dai is *i-- ,� <br /> T pe of>r�it; pNe,,,r Qgddition ❑Remodel ❑ e, p QA�Iu#�,1 rarnlly�of Jnit,. ❑Commercial ❑Industrial � <br /> DESCRIPTION OF WORK: 1IF ❑T.I. txlT QSorikl�- E]Demofition ❑Cha 4.s of Use <br /> 1V)e9 kePieee 616 - -(APNIQ ACS2---- <br /> ASSOCIATED BJILDlNra PERMIT#(if appiicahi+): <br /> NIECHANIdAL,PEkNur APPLICATION! <br /> Type of Project: New AddnLUi1 Et Its";'fa lt�1'ih AP.PLidA"�'ION <br /> — Alteration Repair <br /> Type of Project New Addn Alteration Repair <br /> #of #of <br /> 111111.11111 1r7XCiT6's Aixtures List-or fil iitt- —#°f.,__ <br /> NC–Air Handiinr UnitsMNNIN Fixtures Llai-df Fixtures-------- <br /> ��Forced Air Systemslifin <br /> Toilet <br /> Backflow Preventer(Inside Bicr) <br /> Bathtub <br /> 111111111. <br /> 11111 Boiler Lavatory(Wash Basin r(ni <br /> Boilereration Drinking Fountain <br /> Gas Ficeplac® Shower Floor Drain <br /> MN Wood Stove Kitchen Sink&Disposal <br /> .1111.Clothes Dryer Hooku.s 1111111111111111111111.Ouce(n Dishwasher Grease Trap <br /> Ranee Hood IMIIIIIIIIIIMIIIIIIIIIIIIIIII Other Clothes Washer MMedi al G Drains <br /> Water Heater Other: Gas <br /> IIIIIIIII ��■�,, Sink Service/Bar/Mo lett-) Other: <br /> SPRINKLER t SUPPRESSION SYSTEM <br /> MNChemical or Water <br /> No.of Heads <br /> Mill <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein is true and correct Work 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,cr I am authorized by the owner of thisroPity e to perform the work for which application is made <br /> and t comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> F <br /> Q City of Everett Official Use Only <br /> ' .lid 1vF 1 • 1 P T • <br /> Ow*er/Authorized Age- Signature " r "� <br /> gnature <br /> Cate I (Revised 5/23,20 6) <br />