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#1111.1 <br /> PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING I SIGN 1 SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (F')425-257-8810 I FAX 425-257-8857 I(E)everatteps@everettwa.gov I www.everettwa:gov/permits <br /> (Blue or Black Ink Only Please) 'PROJECT=SITE`lNFORMA 'IoN- - <br /> PROJECT SITE ADDRESS: <br /> � ��� �' 'L ,�-•,, (PROPERTY TAX if: <br /> LEGAL for new construction: Short aor,'Ia6'sutadrr,;ern <br /> �-- -- a' '< attach copy of long legal dzscrlption) — <br /> CONTACT INFORMATION • <br /> OWNER ,�.�.. <br /> NAME: �i <br /> • u TENANT NAME{if Comrnerciall: <br /> OWNER MAILING ADDRESS: rR=E <br /> CITY *` Y� r ,■. d <br /> OWNER PHONE: •� s [[..:_•.rte <br /> STATEAir i' <br /> '- - OWNER EMAIL: <br /> CONTRACTOR NAME: 1")„ <br /> s <br /> rrl lnL <br /> op <br /> CONTRACTOR ADDRESS: sTaE r <br /> cnv <br /> CONTRACTOR PHONE: i. GJ ,►�• STATE \ R zia L0 1 <br /> 560 LCONTRACTOR EMAIL.-�j I � �P11��n "`t(fl r-- , ory-i <br /> C43!4TRAcTOi NGEttSc-4fREf3ljfRErJI: 81j <br /> • 09R T CITY Of-EVERETT auSINasS LICENSE#friEQUIREDI I (2 Ci <br /> PRIMARY CONTACT: 0 OWNER LCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> -_ <br /> Te'A t^ atbio CONTACT PHONE: 4�.,,25 2.5 C7 iO, 50 <br /> �J CONTACT EMAIL: C ci�ll neQ'" VI.L3 'CO <br /> -BUILGING'PERMITAPi'P-OC„-'11IONt tg7''': '. <br /> Existing Use of Bui!din9r � - - -- <br /> Contract Price of Work:$ <br /> Proposed Use of B_!d'sng: - <br /> Heat Source > as ElElectric ❑Other <br /> vil <br /> Buiidin. ype: ra—R.Detazhad ❑SFR2 Attached ODu• <br /> T pe of 'rajat: aria ❑Muiti•FaTiify unit; ❑Commercial :Industrial v ❑New ❑Addition ❑Remade! <br /> DEsaRiPi"ioN OF WORK. ❑'Repair DTI Sin Lear rkder ❑Demolition ❑ ,hap 9 at Usa <br /> Plecilig c2 50icAt o n ctS <br /> we .der o <br /> ASSOCIATED L3IJILDING PERMIT#(if a-.pliatbfe ��Q - " <br /> hiEC}•INtCAL gPERYllt APPLICATION <br /> Type of Project: New Addn C�!1.11MI3It"a �?! RIIt�IStkI�Pl 1CATIt31+1 <br /> fit of Alteration _Repair <br /> — f2Vrrrs' St of Atxhfr #of #of ., <br /> 111111111 - ra .. 'ixti, ,'st-ofr-ixtufes— #of <br /> A1C—Air 1 iandli ng Units ,_ Fixtures s�t of F+rturses--•---_ <br /> Forced Air Systems Toilet Backflow Preventer Inside Bid. <br /> 111111111 Gas Piping <br /> 1111111 Urinal <br /> Mil-. _- Boiler allill Lavatory(Wash Basin <br /> 11111111 Refrigeration _Shower �FloorDr Fountain <br /> Gag Fireplace Floor Drain <br /> 1111111111111111 Gas RangelWood Stove _Kitchen Sink&Disposal <br /> MIIIII Gas <br /> 0 Dustin. Dishwasher Grease Trap <br /> er Hookups Other. Roof Drains <br /> .11111111 <br /> � <br /> Ran <br /> eH ori 111111.1 iaktsdalt=41111.1111.1111 <br /> Other: <br /> rzv�G+:�r3i � Medical Gas <br /> _1111111111.111111111.11 —Sink 5ervicefBar/Mo«fetc.)�Other: <br /> IMIIIININNNNNNNINENEEIIIIMIIIIIIMIIIIMIIIIIIII• SPChe KLE Water NRINR1 SUPPRESSION,SYSTEfWI T <br /> M <br /> e.cf Heads <br /> ACKNOWLEDGEMENT: have reviewed this application and confimt the information contained herein is true and correct.Work done pursuant to <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 walin from <br /> 8u1lding Official before being authorized under any circumstance.I am the owner,art am authorized by the owner of this propert to ert p must comply smade, <br /> h d e <br /> e <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> Y p orm the work kr which applgatian Is <br /> City of Everett Official Use Onty. <br /> ',AS PERMIT <br /> 02- <br /> w•et/Authorized Age Signature AO, ` ` .... <br /> " <br /> (Revts.ad 9/23/24?6j <br />