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PERMIT APPLICATION <br /> 0,57-1- BUILDING / MECHANICAL/PLUMBING I SIGN / SPRINKLER! 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.gov/permits <br /> (Blue or'Black lnieOniy Please) ,ROJEGTtSIT II4PrI RIMA` IO1 AC't<'`Y'e Y.%'-' <br /> PROJECT SITE ADDRESS: (`4 i 4 ( j c s,r PROPERTY TAX#: <br /> LEGAL for new construction: Short Ptaftssubdivi'r"-1cYi""'�n <br /> ---. Lot No.. _ (attach copy of long legal description) <br /> CONTACT{INFbRMA`1tiON .:, " ". <br /> OWNER NAME: _ „:J TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET (CO,I tAX4jam('^ SI— <br /> CI <br /> — y <br /> CIN 'tJ1 STATE W V <br /> 71P LV 1 <br /> OWNER PHONE: 1125 Z$`S.-`025/0 ,OWNER EMAIL: <br /> CONTRACTOR NAME: CAM n ,rl C <br /> CONTRACTOR ADDRESS: STREET 114 <br /> c'Tv sr)LT.,'V vt STATE - ZIP qvzo I <br /> CONTRACTOR PHONE: U <br /> Zf5 Z�q C) 60 CONTRACTOR EMAILt^J Lp e„, Lv1,2,a f n <br /> Cor <br /> ----GSNTRACTQR-LIC€NSE REoutREDI r r 1 <br /> cfrr-OF EVERETT-BUB/MS tICENSE`tf(REgUIRED):.. I Q(D Cr-g--- <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �4.2�,S 2517 C) GO <br /> [ <br /> -.'G <br /> L CONTACT EMAIL:�. dblo a e kej,,, t .co rvl <br /> - `Asp!LbiNG I'LRMI`ftAgnot41 ',`Conk' ", °'tl;ttol,1-+4,,, <br /> Existing Use of Building: Contract Price of Work:S --14b <br /> Proposed Use of B tiding: Heat Source: OGas leetric T❑Other <br /> Building Type: SFR•Detached ❑SFR-Attached Duplex ❑Multi.Famlly.-f#of Units; ❑Commercial ❑Industrial <br /> Type of Projec ❑New DAddition ❑Remodel ❑Rejnair DTA. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1 nSkt Mk CLCAAX.55 Le <br /> ASSOCIATED BUILDING PERMIT#Sit applicable): <br /> MECHANICAL PEItMtT:APPLICATION '-:?., t ' ' 1,';': lPt:UIV1itiNc <br /> ikeRmo9tN*lic'AiloN <br /> Type of Project: New Addn Alteration _Repair <br /> ` #of Type of Project: _New _Addn Alteration _Repair <br /> List of Fjxiuras #of #of <br /> Y�fxfurrrr Fr`xrtires --List.ofxtxtures--- —List-of Fixtures-- #of <br /> Fixtures -- List-of Fixtures —.... <br /> A/C—Air Handiin Units Heat PFixtures <br /> um Toilet Backflow Preventer(inside Bldg) <br /> Forced Air Systems Unit Healer <br /> Gas Piping 'Bathtub Urinal <br /> Boiler Lavatory(Wash Basin <br /> ) Drinking Fountain <br /> Water Heater Refri eration <br /> Gas Fire face Shower Floor Drain <br /> Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Clothes D er Hookups Other. Dishwasher Roof Drains <br /> Ran a Hood Clothes Washer Medical Gas <br /> Exhaust Fan Water Heater Other: <br /> Sink(Service/Ear/Mop/etc.) Other: <br /> ' SPRINKLER.]SUPPRESSION' ' , "` <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT::I 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,stale,and local law. The granting of a permit only authorizes a <br /> ppBuilding Ofcia/before being authorized under any circumstance.I am the owner,ore d am authorized y thework and no devions owneer refrom.of(his property to performDeviations mustst theework forzwh Inch aptpfl afrom the <br /> tion is made, <br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> ' <br /> 1City ofEverett Official Use On • <br /> iAA U. e,...� I..� ( o -1 PERM <br /> ER \yooF —o <br /> �eriAut Age SIgnaturg <br /> Date <br /> (Revised 8/23/21316) <br />