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PERMIT APPLICATION <br /> ,j., ,�1 BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> ‘OldiCITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8510 j FAX 425-257-8857 '(E)everettepSgevsrettwa.gov I www.everettwe.gov(permits <br /> (Blue or'Black Ink Only Please) PROJECT SITEx1NR k i11R 410N° <br /> PROJECT SITE ADDRESS: C.( V <br /> f a 1 PROPERTY TAX it: <br /> LEGAL for new construction: Short Plat subdivision MP <br /> Lot No. (attach copy of long legal description) <br /> CONTACTINFORMATION <br /> OWNER NAME: <br /> € d p_ TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: Ifg� <br /> GTkcET ✓ ` 1 <br /> :- STATE t <br /> y • oral <br /> OWNER PHONE: �"1t� 3a - <br /> �� � In <br /> OWNER EMAIL: <br /> 1-Ac <br /> NAME: ",l: <br /> e l� ll'1 C <br /> CONTRACTOR ADDRESS: STREET 1 Lic '0 <br /> ;,Tv a I <br /> sAZt <br /> STATE A R-- 71r * : 201 <br /> CONTRACTOR PHONE: c• • SO CONTRACTOR EMAIL•. • 4 v( Aiino CD <br /> ryi <br /> NIRA OR-NOENSE 0t3R'Et URED, LISA. ; 0.- R- CITY-OF EVERETT BfISiNE55UtENSEft(RiwQItIlRED)•--#Oto t7_.-- <br /> PRIMARY CONTACT: ❑ OWNER [CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L .ZS 253 O SD <br /> CONTACT EMAIL: <br /> Buhr TNG PERM'AP,01l6ATlOi ::--i ' <br /> Exisflrs Use of Bulldtnr; Contract Price of Work: S I•IP i <br /> Proposed Use of BulfdlnL7; -- ._.. .._�..,„_.. <br /> Heat Source: ❑Gas 41 le trio ❑Other <br /> Building Type: •.FR_Detached DSFR-Attached DDuplex ©Muhl-Fermi 4ofUnits: _ ❑Commercial ❑Industria <br /> l <br /> Type of P ore t' ❑New ❑Addition ❑Remodel ❑Repair. ❑T.I. ❑Sitn ❑Sprinkler ❑Demolition ❑Chan.e of Use <br /> DESCRIPTION OF WORK: <br /> I <br /> 1 Yl c au vl.e.otr puxip and air In ahot1-eg. <br /> ASSOCIATED BUILDING PERMIT#lir efypiicanle): <br /> 'MECHANICAL PERMLTIT APPLICATION <br /> `,:PLUMBING PERMi'1`rAP!?LtiCA7'IC]N <br /> Type of Project: _New Addn Alteration Repair <br /> #of #of Type of Project: New Addn Alteration Repair <br /> Fixtures— Lis f.F_ixtures List ofFIxrures - A of <br /> —Usk 4tti�res d <br /> #of <br /> FrXRe3Yesfxtures Eisfpt Firtierrs .- <br /> AIC—Air Han 716 1i,iraits Fixtures <br /> Forced Air Systems � Heat Pr,<<ma Toilet <br /> Unit Heater M Ur Backflow Preventer(Inside Bide.) <br /> Cas Piping <br /> Scalier <br /> Urinal <br /> Mill Lavatory(Wash Basin) <br /> Water Heater tRef----tion Drinking Fountain <br /> Gas Fireplace Wood Stove l �Floor Drain <br /> magammimm <br /> Gas ----------67c1176---- <br /> Kitchen Sinks &Disposal <br /> Cashes Dryer Hookups Ducting Dishwasher - <br /> Oth€?r: Roof Drains <br /> Fan Nord Clothes Washer I 1 <br /> EZEIll <br /> Exhus(Fan Water Heater other: <br /> mil Sink(Service/6arthloeletc.)_Qtl;er, <br /> S____ CER! _____2ESSION SYSTEM anil <br /> 11.1114 <br /> Chemical or Water No, of Heads M <br /> ACKNOWLEDGEMENT.t have reviewed this application and confirm the Information con famed herein Is(rue 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 <br /> rk and no deviations <br /> Building Official before being authorized under any circumstance.I am the ower r!am authorized by the owner of this property to perform therefrom.Deviations must first authorized in workfor which apwriting <br /> and!comply with the State Contractors Law t 8.27 ROW end 296.200A I4AC. from the <br /> application is made, <br /> City of Everett Official Use Only <br /> Ow,arfAu a e. Signature.. . _ IC . (6 PERM ��A 0 O <br /> 9 SlgOeture Date 1� <br /> (Revised 9/2:3,2 2 <br /> 016) <br />