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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING/SIGN /SPRINKLER f DEMOLITION <br /> 011err. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everettepsCrtevereitwa:gov 1 www.everettwa,gov/permits <br /> (Blue or Black Ink Only Please) PROJECTSIT:EIINFO 1 MAYION W �. . <br /> PROJECT SITE ADD "i <br /> ADDRESS: a '„�, •i <br /> .tr►lr PROPERTY TAX#: <br /> LEGAL for new constnuctian Shur!p'la;,3ubr#trix4nn <br /> Lot No.' (attach copy of tong legal description) <br /> CONTACT INFORMATION . • <: ,. ' <br /> OWNER NAME: i f A <br /> ` A. <br /> a TENANT NAME(If Commercial <br /> OWNER MAILING ADDRESS: sTnEEr ti a <br /> r/�� rrrr__ <br /> cry . '4 <br /> 4�>•P A ..40 a. STATE ' ; <br /> OWNER PHONE: zrr <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: v i fl t t`„i <br /> CONTRACTOR ADDRESS; IC. <br /> 4! <br /> srit=_�r QC1G ./ <br /> CRY lib P > *, <br /> 5 o STATEA ZIP ° s ZQ l <br /> CONTRACTOR PHONE: 2 <br /> So CONTRACTOR. EMAIL t ", "1' _AA .° • ,its ,co <br /> --� CGITRA�'TOS-LiGE��l.SE-#(FE4fdff2ED). ,_ : .. �,r�;._ �' ..1! i1 <br /> r CM-OP-EVER t`JtiSftQE55 LICENSE 1/(REQUIRED)7 '� <br /> - a CiTcf-g <br /> PRIMARY CONTACT: ❑OWNER <br /> ICONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> De40 0 CONTACT PHONE: GJ ZG�(� OST.) <br /> �J CONTACT EMAIL: ins 4, a • 1 keia, V' +co <br /> BUILDING�`ERMI''`�;AEtl sl( d, :Eta . i `�< �t'tt''., <br /> Existin. Use of Buildlns <br /> Proposed Use of Buildin : <br /> QM <br /> Buitddta. T �•F FR-Detached ❑aFR-Attached [��u fax HeptSource: OGas �.t Iectrlu ❑Other <br /> pts: <br /> �.� <br /> T pe of Project: DNew p ultt-Famii 4 of Units; <br /> C7Addition ❑Remodel ❑ ❑Commercial ❑Industrial <br /> DESCRIPTION OF WORK: Re air ❑T.I, OSiwn C1Sprikier ❑DemolitionChan.r of Use <br /> (f�,t,1 ele_L f-r ;c atm° c>e_, <br /> ASSOCIATED BUILDING PERMIT# if apoiicabie): <br /> MECHANICAL;PE tMI1 APPfwICATICiN <br /> Type of Project: New ;z.pY.UiVIBIr �-�'EFtMl7`arQiPLICAYIClIY <br /> Addn WMAlteration Repair <br /> #of .,, <br /> IMO —Fat f_ #of ft of <br /> AlC-Air Handlin. Units lxtures <br /> ��Forced Air SystemsMTIMIN Fixtures <br /> MN Unit Heater Toilet <br /> MN Uackitnw Preventer Inside Bldg) <br /> Gas Plping Bathtub <br /> `Lavato (Wash Basin) MI Urinal <br /> Mai Gas Fireplace immommommaminme Refrf.erativn Shower MI Qnnktn. Fountain <br /> 11111.11.Gas Ran.e Wood Stove Kitchen Sink&Dis.osa( IMMIN Floor Drain <br /> 11111.111 Clothes Dryer �Ducting 111111.111 Dishwasher Grease Ira <br /> Hookups Other. MN Roof Drains <br /> Rare Hoed Clothes Washer <br /> � d� Medical Gas <br /> Sink Servjce/l3arlMofiete-IIIIMIMMINI Other: <br /> SPRINKLER f-SUPPRESSION SYSTEM Othef <br /> Chemical or Water <br /> 111111111.11111111111.11111111111 <br /> ACKNOWLEDGEMENT.mical t have reviewed this applicationNo.of Heads <br /> and <br /> confirm the information contained herein Is true and correct,Work done to this permit must comply <br /> current federal,state,and local law. The granting of a permit only authorizes approved work and no deviations therefrom,Deviations must <br /> and the <br /> Buil <br /> ply with <br /> h hbeing authorized under any circumstance,I am the owner,or 1 am authorized by the owner of this property to ewith <br /> and!comply iallb the Slate Contractors Law 18.27 RCW and 29circumstance. <br /> am v✓AC. <br /> w first a authorized inappwritlication <br /> io IS <br /> Y perform the work for which apFlf�alicn is made, <br /> City of Everett Official Use Onfi, <br /> ` -+'. PERMIT# <br /> Ow•ariAufhorfzed Age a>k-- e1 • 30• 1 1 f <br /> Signature ti-•' # jj` ti ^'' / /S <br /> Dote <br /> (Revised 12312016) V <br />