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PERMIT APPLICATION <br /> ( -i*.'6.7.7.' BUILDING / MECHANICAL/ PLUMBING /SIGN l SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8B57 I(E)everetteps, evereltwa.gov I www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE.INFORMA ION ' <br /> PRt)JECTSITE ADDRESS: -� �� ' =:_. :' " �� <br /> l "17� 5 PROPERTY TAX#: <br /> LEGAL for new construction: Short Platisubdivislon <br /> _ _e_ _ _tot No.' (attach copy of long legal description) <br /> CONTACT-I INFORMATION <br /> OWNER NAME: z Lt itymbrArtko <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: srrtEErJ` f <br /> I CITY Etief +- STATE <br /> OWNER PHONE: r <br /> >�l7 [ ZIP <br /> €"" l4) TOWNER EMAIL: <br /> CONTRACTOR NAME: CA i lin ,}1 C <br /> ( <br /> CONTRACTOR ADDRESS: STREET 14, 5roCt, <br /> CITY 'CA-Lit \A„)1 r( ..._ Q <br /> STATE - ZIP <br /> CONTRACTOR PHONE: (--" Z el C-) 150 JCONTRACTOR EMAIL ) <br /> CONTRACTOR LICENSE#{REOUtRi:Ca): «y-,-ate. �-y�p (''�(�j— �'""�'�'�Q ��.'�•�V� .coal <br /> � "�' r�"```DC/SRT CITY OF-EV€RE-r BUSINESS LICENSE#(REQUIRED): OC 1 D <br /> PRIMARY CONTACT: 0 OWNERCOtNTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: _ --- <br /> CONTACT PHONE: 142s 2.99' O'3SD <br /> CONTACT EMAIL: - -Jt„ioIj e CAV 0,41, ,Co ill <br /> BUILDING'PERMIT-APPLICATION A <br /> ExistingUse of Building: + <br /> � iX Contract Price of Work:$ kir _ <br /> Proposed Use of Buildin <br /> Heat Source: Gas ❑Electric ❑Other <br /> Building Type: IFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family_{i of Units: <br /> ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTA. ❑Sin ❑Sprinkler ❑Demolition ❑Chan e of Use <br /> DESCRIPTION OF WORK: <br /> PV. Itt-t &Ja5 ilot WCbtec hea4t-r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION <br /> Typo of Project: New ` Addn Alteration �Repair PL�,1�11$�N("� P��MI`I�-A�PI'ICATIIIN <br /> #of Type of Project: New Addn Alteration Repair <br /> Fixtures—— / f_0ltixILW8S_ #of #of <br /> Listof Fixtures—- #of �— --- <br /> FfxiiJr6S __ _.___i ist ofFixtbres <br /> rxturns — —kfsf or F[xtur s <br /> AIC—Air Handling Units Heat Purn Fixtures <br /> Forced Air Systems f' 'Toilet Urinal w Preventer(Inside Bldg) <br /> Unit Healer Bathtub <br /> -�--�••- Gas Piping Boiler Urinal <br /> Water Heater Lavatory(Wash Basin) DrinkingFountain <br /> Refrigeration Shower <br /> Floor Drain <br /> GasCas Fireplace Wood Staves Range Kitchen Sink&Disposal Grease Trap <br /> [Otocting Dishwasher <br /> Clothes Dryer Hookups Ott-ef. Roof Drains <br /> Range Hood Clothes Washer Medical Gas <br /> O <br /> Water Heater <br /> Et Fan Other <br /> xhausSink(Service/Bar/Mop/ate) — ther: <br /> SPRINKLER/SUPPRESSION SYSTEM _ <br /> Chemical or Water No,of Heads <br /> current federal,state,and local law. The ACKNOWLEDGEMENT:I have reviewed This application end confirm the information contained herein is true and correct.Work done pursuant to this permit must comply with <br /> d work and no <br /> Building Official before being authorized under t any circumstance.of tlam the owner,t only authorizes or I am authorized bytthe owneations rof this property to perforefrom.Deviations must m the work for which applist be authorized in cfrom the <br /> ation is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> -3 <br /> Ow er/Auu rized Age 5g�turn 1 <br /> 1PEO <br /> S fi < OZ <br /> Date <br /> (Revised 9/2312016) <br />