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PERMIT APPLICATION <br /> OLTBUILDING I 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)everettepseverethfra.gov I www,everettwa.gov/permits <br /> (Blue or Black laic-Only Please) PRC3J GT"ul IN 4#Nll�l'c°I ? >�� !i `� <br /> ee ale .9\' c.4.-- ,... <br /> PROJECT SITE ADDRESS; id <br /> PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisobdiviston <br /> Lot No. (attach copy of long legal description) <br /> — <br /> CONTACt-INOORMA' Ibht <br /> OWNER NAME: &nib i ?ef'ccy')c <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �"Q <br /> CITY 41, <br /> �•• STATE G ZIP 4 - i <br /> OWNER PHONE: .,..11 1 OWNER EMAIL: <br /> CONTRACTOR NAME: i �Y1 C – <br /> t <br /> CONTRACTOR ADDRESS: STREET I4 <br /> CIN "T.!� 5,^" z1.r STATE - ZIPCtiC 0I_ <br /> CONTRACTOR PHONE: 2. CI 10 0 CONTRACTOR EMAIL• l ", 'a <br /> sa ,A0 4 –14 . + I rig *CO <br /> CON<TRACTOR-LICENSE#(REQUIRED.i f t.'1-.2Prz.cgs p.4. ...Ct'tai-Olt-EvERE''fl- u8tNLS8.tICENSE :_REQUIRED <br /> PRIMARY CONTACT: D OWNER CONTj � �" <br /> !Si/CONTRACTOR 0OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 1.42.6 25cq 055 <br /> ) CONTACT EMAIL: <br /> - ;.BUILDlNGI ERMlli'i►pt ji,tt' toP4 'c`i'ti <br /> a air d r' ` <br /> Existing Use of Building: Contract Price of Work:$ • •aka <br /> ,Proposed Use of Building: ---= <br /> .Heat Source: ❑Gas le.,:-ctrIC DOther <br /> Building Type: R Detached DSFR-Attached DDuplex ❑Multi-Famil tl of Units ❑Commercial Dln <br /> : — <br /> 61 <br /> Y dustrial <br /> Type of Project. DNew DAddition ❑Remodel DReoalr DTA. DSi+n OSprinkler DDemolition DChanre of Use <br /> DESCRIPTION OF WORK: <br /> 03fatIt /lee <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> PICMLP <br /> MECHANICACPERNIEr APPLICATION ' ,r <br /> "< ', '=;+l,Li1MBINtr'ktRiVI'itilOpLlCA' 'FOM <br /> Type of Project: New Addn q)teraHonRepalr <br /> �€of — Type of Project: New _Addn rAlteration Repair <br /> '_#°fxirrres __ Lis t_Otrixtur_sts_ #of #of <br /> riiXfures r lsi os faxtures— List of-Fixtures---.. .. #of <br /> -�". <br /> �rxhires --- — ..—___List of Fixtures <br /> ,AJC-Air Fiandlln Units Heat Pump Fixtures <br /> Forced Air S stems Unit Heater Toilet Backflow Preventer Inside Bid.) <br /> Bathtub <br /> Gas Piping Boiler Urinal <br /> Water Heater Lavatory(Wash Basin) Drinking Fountain <br /> Refrigeration Shower <br /> Gas Fireplace Wood Stove Floor main <br /> Gas Range Kitchen Sink&Disposal Grease Tra <br /> Clothes Dr er IDL"-- -. <br /> Dishwasher <br /> Other. Clothes Washer Roof Drains <br /> Ran e Hood Medical Gas <br /> Exhallst Fan Water Neater Other. <br /> Sink Secy#r~efBartMt€ Iatr.} O#her: <br /> PF._._ _ SUPPRESSION,S'YSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT;1 have reviewed this application and confirm the Information contained herein Is true end comet(. Work done pursuant to this permit must comply with <br /> current federal,stale,and local law. The granting of a permit only authorizes approved work end 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,or 1 am authorized by the owner of this property to perform fhe work for which application is made, <br /> end I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> al <br /> -4. — (..3 Ai, <br /> 1 PERMI O� <br /> Ow'sr/Authorized Age /i, <br /> 9 Signature Date <br /> (Revised 9/21 76J <br />