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PERMIT APPLICATION <br /> OILBUILDING / MECHANICAL/ PLUMBING 1 SIGN ! SPRINKLER I 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,govtpermits <br /> (Blue or Black Ink Only Please) PROJECTtSITE INFORMA 'ION:1' '-:'-'''': '''''C''::. <br /> PROJECT SITE ADDRESS: 410,3 a7 1" 4.,,,e,,, j ,w PROPERTY TAX#: <br /> b <br /> LEGAL for new construction: Short P€alis diviston <br /> Lot No. (attach copy of long legal description) <br /> • <br /> �y <br /> MCA <br /> j CONTACT-i1NFORMA•t iON r •. '- <br /> OWNER NAME: *''1 0 {4} 11 1 <br /> TENANT NAME({f Commercial): <br /> OWNER MAILING ADDRESS: > PEET % + p•" <br /> . .. CITY hry.-a/Cw+'8 .eiV'yf- STATE V,.v t a L`P ��20 <br /> OWNER PHONE: 2.CDG 2(.1 5?9(0 OWNER EMAIL: <br /> CONTRACTOR NAME; . s in ` 1n C <br /> CONTRACTOR ADDRESS: STREET 14. roj <br /> STATEtri— ZIP <br /> CONTRACTOR PHONE: 42.^} �y <br /> 5 2 Ct. OC CONTRACTOR EMAIL...,. 4 `'+ 1. Ag / I no ..Co <br /> - PRIMARY CONTACT:SE-#OW (JIRFD):- "-,(Y� - ' <br /> Cf <br /> �N7•-R�.G-TQR-NOE 'PY`-OF EVERETT BUSINESS-LICENSE#(REC]tJiFtEt1�-1-0.679-g - <br /> NER (CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: L C'•ZS 25 C7 t50 <br /> CONTACT EMAIL: ► . aink2 , I CO <br /> 81(tLD1NC,`P >tMhptvPrlce of O .h ''vYs 'a="''''"-.'t � <br /> I'l,tt�dTl <br /> Existing Use of Bui(din <br /> Work:$ 2. :POT r <br /> Proposed Use of Building: <br /> !Heat Source: Xas ❑Electric DOther <br /> Building T pa: E SFR-Detached ❑SFR-Attached El Duplex ❑Multi-Fam€t 4 of Units <br /> ❑Commerdal ❑Industrial <br /> Type of Project: ONew ❑Addition LI Remodel DRocla-r DTA. pal DSor:nkter DDemolifion 0Chang€e of Use <br /> DESCRIPTION OF WORK: hepfiet2_, T.S - ' 1^' 1(A(,,e., <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL;PEt23V1iT APPLICATION " y 1 <br /> ,y1� <br /> 77::77:77,77-77--A77 <br /> , �.�}M�#f�l{3r I rC,t ti p� r`.�Yr N <br /> Alteration Repair <br /> #of of — Type of Project: New _Addn Alteration _Repair <br /> — Ftxtr�res �t 1 F� ftrt�s Fiztilras H t fit at rkdures._.,__ ti of #of <br /> —._ <br /> Fixtures die#©€h7�rCtlxes List-efFlifures- <br /> NC, Air Handling Units Fixtures <br /> r a(Pump ToileE <br /> Forced Air Systems Unit Heater Backflow Prevenler nside gid9? <br /> Gas Piping Bathtub Ur{net <br /> Boller Lavatory(Wash Basin) <br /> Water Heater Refrigeration Drinking Fountain <br /> Gas FireplaceShower FlaorDrain <br /> Gas RangeWood Stove Kitchen Sink&Disposal <br /> Ouctin p Grease Trap <br /> Dishwasher Roof Drains <br /> Clothes Dryer Hookups O cti <br /> Ran.e Hoodhe--___ Clothes Washer Medical Gas <br /> Exhaust Fan Water Heater Other, <br /> SincService/BarlMonlelc.' Othe : <br /> SPRINKLER'!SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the infcrmaticn contained herein Is true and correct, Work done pursuant to this permit must comply with <br /> current federal,slate,and local law. The granting of a permit only authorizes a <br /> ppand no deviations threfrom Deviations must first <br /> w <br /> rk <br /> Building Official before being authorized under any circumstance.I am the owner,ored amo authorized by the owner of this property to perform the work fort whichin application on is made. <br /> and I comply with the State Contractors Law 18.27 ROW and 295.200A WAC, <br /> City of Everett Official Use Only <br /> !,..±— L Q PERM .' k 0 <br /> 0\ I <br /> Ow=ertAuthortxed Age- t ! 1 d •2 , O <br /> Date " (Revised 9r2312016) �" <br />