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PERMIT APPLICATION <br /> OSETTBUILDING / MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 l FAX 425-257-8857 I(E)everetteps(geverettwa.gov I www everettwa.govlpermits <br /> (Blue or'Black Ink Only Please) ' PROJECT,SITE INFO tttiA' IOtvI Y°, <br /> PROJECT SITE ADDRESS: ��71°I' Vial not Si- <br /> LEGAL for new construction: Short Platisubdivls,on PROPERTY TAX(€ <br /> �_i <br /> Lot No. (attach copy of long legal description) <br /> CONTAC Y`INFORMA7'lf3Nl` <br /> rt <br /> OWNER NAME: at .r 444 /r <br /> ..Pi TENANT NAME(1f Commercial): <br /> OWNER MAILING ADDRESS; Rt_r l l + v-iv " <br /> cry <br /> ,WA _ <br /> STATE p <br /> OWNER PHONE: Q 5 524 C474q O� <br /> C> OWNER EMAIL: <br /> CONTRACTOR NAME. <br /> c. <br /> CONTRACTOR ADDRESS: STREET l L} roctw <br /> oi <br /> cif IOW (�� <br /> STATE i. t t, ZIP e v -: 0 ( <br /> F <br /> CONTRACTOR PHONE: L.- Z�CI 0 • r <br /> GQNTRACTOR EMAIL M, �, 411illi °,IIE.`itfl .COry)• <br /> CONT____L-I£E JSE#(2E(+�aREt3f:(._(�r� <br /> t' s sR-4---CIT 0P-EvE TP-SUSiNESSL10ENSE-#(REQUIRED)'--f 9 — <br /> PRIMARY CONTACT: ❑OWNER I CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> CONTACT PHONE: 1425 z5 t (:) So <br /> r+! CONTACT EMAIL: <br /> dediato a cArke ' CO ni <br /> ',Bump it•iG( mi 'Areiatidour " Y;lYo , <br /> Existing Use of Building: <br /> Contract Price of Work:$ .242{ <br /> Proposed Use of Building <br /> Heat Source: ❑Electric ©Other _ T <br /> Buiidine Type: ?AK FR-Detached ❑SFR-Attached DDuplex ®Multi-Famify4 of Units' <br /> T pa of Pills.:-.: ❑New ❑Addition ❑Remodel ❑Re;yair ❑Commercial ❑Industrial <br /> DESCRIPTION OF WORK: DTI �Stin C}5orlttk er ODemolition ❑Ghana of Use <br /> Irkici <br /> .. C -tiS kt-4,.-rrtaems. <br /> ASSOCIATED BUILDING PERMIT#of applicable): <br /> M +CHANICAL P kMiT AP PLCCATi C7tN I <br /> Type of Project New Addn �, MI �'° RMI;#'; !PL tCAT(+DIV <br /> rr —■.I— Alteration Repair <br /> 4of <br /> Lis4xfFi sYuFas......__ .. <br /> #of #of _ <br /> Mill AIC—Air Hand(in► UnitsFktttr6iztures fist cifit-/xtwre —Etst-offixtures--_..___ <br /> kleat Pump Fixtures <br /> ��Forced Air Systems Boiler N Backflow Preventer Inside <br /> Unit Heater Bid t <br /> _Gas Pipinginn �Bathtub �Urinal <br /> Boiler allilLavatOry(Wash Basin) <br /> MIN Refrlgereilon t�rinkiDr Fountain <br /> Shower Floor Drain <br /> Gas Fireplace <br /> Wood Stove <br /> Gas Raheo _Kitchen Sink&OIs sal <br /> DuclinyMI <br /> Grease Trap <br /> Min NMI. <br /> Clothes 0 er Hookups O Dishwasher Roof Lal G s <br /> MM.Range Hood frier, 11.11111111 Clothes Washer <br /> Medical Gas <br /> Other: <br /> allillim......._111111111111 am=Sink(ServlcefBar/Mopletc.) Other. <br /> SPRINKLER]SUPPRESSION &YSTBNI <br /> Chemical or Water <br /> No.of Heads <br /> 111111111111111111111111111111111111111.1111.11111111111111 <br /> ACKNOWLEDGEMENT 1 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 or 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,ort am authorized by the owner of this property to perform the work for which a li F y <br /> and I comply with the State Contractors Law 18.27 RCW and 206.200A WA C. <br /> pp talion is made, <br /> `, <br /> (-12City of Everett Official Use Only <br /> A ,,ii_.,,,, _i ‘ -at-f- ii5 PERF <br /> , SO <br /> (7w.sr/Authorized Age Signature Z - Q S 2 <br /> Date VVVV <br /> (Revised 9/23/2076) <br />