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PERMIT APPLICATION <br /> 04-ErrBUILDING / MECHANICAL/ PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> t,P)425-257-8810 I FAX 425-257-8857 1(E)everettepst e•,ereftwa.gay I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �/2.0 ,,, <br /> it PROPERTY TAX#: <br /> LEGAL for new construction. Short PlaCsubdivi,.om <br /> Lot vo._ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: <br /> * s rl i TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /♦l 0 20DX,, a <br /> / /f +7L, ThsTAIEPl <br /> OWNER PHONE: 7 r .t/ <br /> ----- — 14 OWNER EMAIL: <br /> CONTRACTOR NAME '' '1 s <br /> n in C <br /> CONTRACTOR ADDRESS: `t� <br /> S-REE- aa <br /> CITY ,, <br /> CONTRACTOR PHONE: M S A 7'r' e :2.1 <br /> Q Q SO CONTRACTOR EMAIL: R , 11) <br /> CONTRACTOR LICENSE t�(nEQt3+REiJ): kVA' - . � .# I i „IA 1� �((j/ .�[} � <br /> k R • CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): `I O j q O <br /> PRIMARY CONTACT: ❑OWNER ;ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: -- <br /> Debb p_�LY� CONTACT PHONE: 4.2.5 ZSci <br /> Di <br /> � CONTACT EMAIL: `_2CA, AO 'CO <br /> BUILDING PERMIT APPLICATION <br /> Existln' Use of Building: - <br /> Contract Price of Work:$ / ♦ , p <br /> aroDosed Use of Buildin _ _. �_�.. _ .�.. <br /> Heat Source: tIGem <br /> BU,t,itng Tv e: to: i-R.Detached C)SFP-Attached- DElectric ❑C3tltsr <br /> 1c.hed ❑Du fex Dlndust <br /> Ty n of Project: ❑New P ❑Multi-Farrtll -�of Units, _�� ❑Corame,�cial ❑Industrial <br /> ❑Addition DRemodel QRepair ❑T.I, ❑Si n OSprinkler [Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> install ACci- refitLei oas r <br /> tacco <br /> ASSOCIATED BUILDING PERMIT#Of appiicabie): <br /> MECHANICAL PERMIT APPLICATION <br /> Type of Project; New Addn PLII.IMB# G pERMITAPpLICATIC11l� <br /> Alteration ,_Repair <br /> #of Type of Project: New Addn Alteration Repair <br /> ftxPa,res _..1.,i$1_0(Fixtures Fix#of #of <br /> rres LJstotFixtura LdstatFixtur-es #of <br /> imirglip Air Handling IJniisixttrras Fixtures ...-List of Fixtures------- <br /> Ifc (t <br /> Air Sysfem rNINIIIN Urinal Preventer Inside Bldg) <br /> ! tom Bathtub <br /> Urinal <br /> Lavatory(Wash Basin) Drinking Fountain <br /> Grease <br /> Gas Fire Refrigeration <br /> plane Wood Stove FloorDrain <br /> Gas RangeKitchen Sink&Dis osal GGrease Trap <br /> MIN MN Ducting <br /> Clothes Dryer HookupsOthDishwasher Roof Drains <br /> Other: Clothes Washer <br /> Medical Gas — <br /> ,em.__IINIIIII1Lr,nm.....___EDmnllaM - <br /> Earla 11111.1.11111111.11.1.11.11111.11111111 <br /> Other: <br /> �- <br /> Sink SenricetBartivlapletc.) Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water <br /> No.of Heads <br /> 111111.1111 <br /> ACKNOWLEDGEMENT:I have reviewed ties appli,atr r end cer,tirm the information contatned herein is true and correct.Work done pursuant to this permit must comply <br /> ourrant federal,state,and it:cat law.. The granting of r3 permit only authorizes approved work and no deviations therefrom,Deviations must first he authorized <br /> Building Official before being authorized under any circumstance,t am the owner,or f am authorized by the owner this r n.pty with <br /> and t comply With the State Contractors Law 18.27 F?Ct4'end 296.2200A WAC in writing//cm me <br /> property to gerfontt the work for v�htch ar�r,Jicatitzrt is',bade, <br /> City of Everett Official Use Only <br /> ir <br /> x.1414 u � •!7� fS PEwy <br /> Qw gn erlAutharlxed A 4 . .'1 'o� <br /> Signature <br /> bale <br /> (Revised 8/23!2016) <br />