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PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING i SiGN / SPRINKLER 1 DEMOLITION <br /> 01461.7 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (A)425-257-8810 I FAX 425-257-8857 I(E)overetteps a(geverottwa.905 1 www.everettwa.gov/permits <br /> {81tae `1P Black kik Q t11y' I�Ieae} p�\V.try y �F <br /> PCT S17'Ea11+11?UIMA`t'iOt t <br /> PROJECT SITEADDRESS: ( ST SE <br /> LEGAL for new construction: Short' . PROPERTY TAX#: <br /> Lot No.' (attach copy of long legal description) <br /> OWNER NAME: h F'"I s IIP r0 0 <br /> - TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS; STREET 24✓ , 6r s <br /> CITY <br /> r GSTATE p,f}. Z q(Z 200 <br /> OWNER PHONE: ♦1 rt{- w <br /> . OWNER EMAIL: <br /> CONTRACTOR NAME: If 1 r <br /> Its Inc <br /> CONTRACTOR ADDRESS: STREeT114, „o ,t, _„ <br /> oi <br /> CITY G',ei 4�+ <br /> ... ... STATE 11-- ZIP tK ' 2.• , <br /> CONTRACTOR.PHONE: U 2.�'JGI <br /> 60 CONTRACTOR EMAIL.. �I 7 L <br /> CANT-RAtaT�3F�LIC ENSE-a�(1�EQuli�ED):. __ _ !��. �I��► ,�� <br /> 5R 4,-_. <br /> `f''r "�'` - CITY OF EVERi=TT 8U3iNESS LICENSE 7¢(REQtJtREa): 10.(0 <br /> PRIMARY CONTACT: ❑OWNER Lt CONTRACTOR O OTHER(Please Specify) <br /> CONTACT NAME: — — <br /> T CONTACT PHONE: 4-ZS 259' C.) 50 <br /> 1J CONTACT EMAIL: r a ^ CL"Tc • •[O <br /> BUILDINC--?ERMITAPP SikhL`1't Y k .,, <br /> EXistin Use of Buildin : <br /> Contract Price of Work:$ bd. .. O �' <br /> Proposed Use of Building _....._�_. <br /> BuildingT o ►+ Heat Source: Was DElectric Otter <br /> SFR-Detached ®SFR-Attached OOuplex OMuitl-Famii -#of Units- _ _dusr_ <br /> WORK: p A �....___„_ OCommercial ❑Industrial <br /> DESCRIPTION Typeof :O New DAddition ❑Remodel ❑R air OTI, OSi.n ❑S rinkler ❑Demolition OGhan a of Use <br /> ) ± u A C. <br /> ASSOCIATED BUILDING PERMIT#(if angiicabie): <br /> MECHANICAL£"ERMIT APPLICATION <br /> iLlJMIN�'p? IPY:ICAY 1;71 <br /> Type of Project ,_New _' R'lVi1�"`.. N <br /> Addn Alteration Repair <br /> tF of Type of Project; New Addn Alteration <br /> ,L.Ls.t_a_fEixfuzes.. #ofRepair <br /> Ft foray List of Fixtures— __ t of #of <br /> F7.kiiiY�s' _— —.—LIs1-vf Fixtures_—...__ ._ <br /> fixtures --lrtsl of Fixtures <br /> maw Air Handling Unils Fixtures —~- <br /> Heat Pump Toilet <br /> Diced Air Systems Unit Heater Backflow Preventer Inside F3idg) <br /> all <br /> Gas PipingWater HeaterMilli Refrigeration Bathftatr Urinal <br /> Lavatory(Wash Basin) <br /> MN Drior Ft+untair. <br /> MM. Shower Floor Drain <br /> Gas Fireplace <br /> M.Gas Ran e Millill Du cid Stove Kitchen pink Dispas l <br /> MINODuclin Dishwasher Grease Tra <br /> Clothes Dryer Hookups Roaf Drains <br /> ME Ran.e Hood Other: Ciathes Washer <br /> 111.10 <br /> Water Heater Medical Gas <br /> 5lnk(Service/Bar/Mofete. Other: <br /> Other: <br /> SPRINKLER'!SUPPRESSION SYSTEM <br /> Chemical or Water <br /> No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Information contained herein is/rue 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 approved work and 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(he work for which a ticaEo <br /> and I comply with the Slate Contractors Law 98.27 ROW and 296.200A WAC, <br /> PP ton is made, <br /> City of Everett Official Use Only <br /> LC PERMIT- y-- <br /> (e________ <br /> Ow,or/Authorized Age. n.0 _I t O{g lJ 4�1 I � /`��` <br /> g Signature �/�) 1. <br /> Gate <br /> (Revised 9/23/2018) <br />