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PERMIT APPLICATION <br /> OLTBUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER 1 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@everettwa gov I www everettwa.gnvipermits <br /> (Blue or Black InkOnly Please ) ' 'PROJBCT BI' , INP, Rl l 1TIt N ` ',?.. ,4.4;tb>. ,''_ <br /> PROJECT SITE ADDRESS: 1.40(50 v15 TA FL,A C F' PROPERTY TAX#: <br /> on 1 <br /> LEGAL for new constrvctlon: Short Platlsubdivisl <br /> t _Lot No. (attach copy of long legal description) <br /> CONTACT,'INFORMAYION >. „ <br /> OWNER NAME: LJ 1 NA R\l''ie'\t <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS; sTREEr L4q 50 VII STA ce. <br /> CITY •C�,CI STATEVIA ZIP:. `1'32O3 a <br /> OWNER PHONE:2-04P 393 OGQ' OWNER EMAIL: <br /> CONTRACTOR NAME: C' '1aT1, ri in C <br /> CONTRACTOR ADDRESS: STREET 141 br o <br /> 'LSA t STATE d, �" J <br /> CITY <br /> R- ZIP � el <br /> CONTRACTOR PHONE: 42.S Zia � S0 !CONTRACTOR EMAIL kiln ti) �� oryth,p,a rn .Cpm <br /> _ ._-.6OPI-TRACTOR-LIC€NSE#fREc UiREi ):CAI ectsR'4--CITY-OP —+1-�+.�tY-LpD <br /> PRIMARY CONTACT: 0 OWNER CYCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L.,,,, .i6.1 t...2S 259' yO, 5--D <br /> ��''C <br /> CONTACT EMAIL: .: t e WI ►te_ .co ni <br /> -`BIJILc,nsite-", 'iw`fonitikO '.i(0)100n4,4 : .94., , <br /> ,Existing Use of Building: Contract PrIce of Work:$ 0 00 <br /> Proposed Use of Building: "' <br /> Heat Source: ❑Gas Electric E]Other <br /> Building Type: `6e7SFR-Detached ❑SFR-AttachedI Duplex DMultl-Famlly-#of Units: OCommerclal ❑Industrial <br /> Type of Project: ONew OAddition ❑Remodel Repair DT I, ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> t rtvkati EW dv cki eSS <br /> ASSOCIATED BUILDING PERMIT#(if a pilceble: <br /> MECHANICAL sPERMi"1"APPLICATION' ,'> P <br /> , - ';' ,-',I?"LUNEEf IItIGt'��+l:�i_EfAI'!{�1IiP,P.ti`IC.atr<olV <br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair <br /> ttof — <br /> 1 LisLof Fixtures #of #of <br /> Pr mutts list of.Ftxtarea....... #of <br /> pixtures. "__.__Lts1 -Fixtures----..--...�_ - —,List of-Fiuttrrer- ..__ _.._. <br /> A/C-Air Handling Units Heat PumpFixtures <br /> ItToilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems � �Unit Heater Bathtub <br /> Gas Piping Urinal <br /> Water Heater Boiler Lavatory(Wash Basin)) Drinking Fountain <br /> Gas Fireplace Shower Floor Drain <br /> Wood Stove Kitchen Sink&Disposal Grease Tra <br /> Gas Ran 8 Durfin p <br /> Clothes O er Hookupstther Dishwasher Roof Drains <br /> Ran a Ho©d Clothes Washer Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Bar/Mop/etc.) Other: r <br /> SPRINKLER,/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> current ACKNOWLEDGEMENT I have reviewed this application and confirm the Information contained herein Is true end correct.Work done pursuant to this permit must comply with <br /> rizes approved <br /> rk end no <br /> federal, <br /> Official before being authorized under)ng of a anny circumstancet .l amothe owner,or amoauthori ed byltheons therefrom.Deviations must owner of this property to performstheework forZwhich applicfrom ation is the <br /> and I comply with the State Contractors Law 18.27 RCW and 296,200A WAC. <br /> made, <br /> City of Everett Official Use Only <br /> s PER I <br /> Ow erlA....4 Uge fa* ture 1.1 -�r , It 0 <br /> na <br /> Cate <br /> ('Revised 9/23/2015) <br />