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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I SPRINKLER/ DEMOLITION <br /> :677 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-3857 I(E)everettans@evere,twa.gov 1 www.everettwa.goufpermits <br /> (Blue or'Black Ink Only Please) PROJECTSITEINFORMATION <br /> PROJECT SITE ADDRESS- ‘0 Ct 4 in --oz, f <br /> ' PROPERLY TAX#. <br /> LEGAL fQ new construction: Snort PIatisubdivis=on <br /> _,,,,..____..__ of N. (attach copy,of long legal description) <br /> CONTACT INFORMATION • . . <br /> OWNER NAME: <br /> • '- ,106 11t 0 -46TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS; stae=_rC <br /> ,. '+f .. <br /> CITY i' //fi�rr'2-0 <br /> y.. �.y� ._ <br /> STATE LA _'' CI*(3 �,— `fir <br /> OWNER PHONE: .? ' 1{ i OWNER EMAIL: <br /> CONTRACTOR NAME: -i [ ill ll <br /> CONTRACTOR ADDRESS: STREET IL}. f6 * <br /> C TY i s to°S /.{ <br /> .,... STATE -- _,,, L &�^ I <br /> CONTRACTOR PHONE: �GI 0560 560 CONTRACTOR EMAIL-V .,,. ti't • AA 1, ,!_lit lint .,CO 'l__, <br /> CONTRACT-0 r'-LICE E- (1=?EOLIiRED) -- A IL:4 u -f,r <br /> R etTY-Of'EvE7-r SustNEss LtcErssE#(REcatitrrECI. 0(1, <br /> PRIMARY CONTACT: 0 OWNER OONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: <br /> 'DOW°Lib <br /> CONTACT PHONE: 142. ZSQI (t.::) 50 SD <br /> �„ t,. <br /> CONTACT EMAIL: „ t, 4-T, •C• <br /> LD , e ,e f�T <br /> Existing Use of SuiidtnD; Contract Price of Work:$ . ..-041. <br /> Praoased Use of B+.ri;din __ _....r__.... _. <br /> Heat Source: ❑Gas W&lectric ❑Other <br /> Buiiding Type.: OSFR-DE ached OSFR tach ODruklex r°_ <br /> � ��of� ❑Mul.t rarnily-?t of Units- ❑Commercial Olndusfrial <br /> _Y R 'oJ eu`: ❑New OAddition OR,.model ORepa r OT.i. OS3g,n oa'orinklar ❑Demolition O'Change of Usg <br /> DESCRIPTION OF WORK: <br /> S+ a/co 1i <br /> a33ociATED BUILDING PERMIT#(if applicable): <br /> Mo CH'ANN SAL PERMIT APPLICATION <br /> 1°CUMBIN 'SPRMI"�t'k ,P.I:ICATION <br /> Type of <br /> ! Addn <br /> Alteration Repair <br /> f of /) Type of Project: New Addn Alteration Repair <br /> Fixture's... _.'s,s,t.i2/.F.1Xtu(.3ts R oftr <br /> Fart jr,* . 4t,,,f_e a, of <br /> as #of Ltst atFltttt25 <br /> �R. 'c Air Handling Units Fr`xltfres Fixtures — t`of'F*Xctrr s — <br /> MN Forced Air Systems Heat Pump Toilet <br /> Sa tl0ua Pratte rater (nsi Bldg <br /> Bathtub Urinal <br /> LBvato Wasp Basin) Frinkinr Fountain <br /> Gas Fireplaceimin Ri frftgeroi S ri Shower <br /> Wood=11 <br /> Ducting Stove Kitchen Sink&Dis peal Floor Drain <br /> Grease Trap <br /> Clothes pryer Hookups Dishwasher Roof trains <br /> IMORan e Hood slater aasr Other: Gas <br /> Wafer Heater Other: <br /> Sink SarvlcelEarif4o)aldtc.j Other: <br /> MN <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water <br /> No.cf Heads <br /> ACKNOWLEDGEMENT:I have reviewed this app,icatron and ccnfrrm the Information contained herein Is true and correct.Work done pursuant to this permit must corn*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 Sr.wrong from <br /> Building Oficial before being authorized under any circumstance.I am the owner,Cr!arr;authorized by the owner of this properly to perform the work for which application <br /> the <br /> is node, <br /> and t comply with the State Contractors Law 18•27,qCW and 23E.2GOA WAC. <br /> Orly of Everett Official Use Cr4,• <br /> P <br /> 000 ar/Authorized Age gi <br /> nature1 tO ERM <br /> 5l nature evrssd 9 <br /> Late Fi <br />