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PER <br /> IT APPLICATIO <br /> BUILDING / MECHANICAL I PILUMBING I SIGN N <br /> SPRINKLER/ 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)everettens@everettvva.gov I www-everettwa.govlperrnits <br /> (Blue or Black Ink Only Please) PROJECTSITE INFORMATION <br /> PROJECT SITE ADDRESS: 609 J 2 <br /> t PROPERTY TAX#: <br /> LEGAL for new construction: Shot Plat/subdlvision <br /> Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> IMENIMit -- <br /> e,r a5ct TENANT NAME Of Commercial): <br /> OWNER MAILING ADDRESS: sTREET x.009 e PL <br /> CITY ti I(co STATElit) A ZIP r ,' 2O <br /> �r <br /> OWNER PHONE: t,+ .• a s 7 z Air <br /> OWNER EMAIL: <br /> CONTRACTOR NAME, '♦ f to C <br /> CONTRACTOR ADDRESS: aTREEr 14 f. roc,# , _ <br /> ci, ► , Lt./Vt. (�� <br /> '•'_" STATE A. -- ZIPdir • 2410 1 <br /> CONTRACTOR PHONE: s""L <br /> COso NTRACTOR EMAIL t ,�,.,�. �' - .JA ..!. M,I Co,. <br /> CONTRACTOR LICENSE#fREQ+JIf�Ei7); r �j � <br /> AA sly .. "', 810" C'S CITY OF EVERETT BusINFSS LiCENSE#(REQUTREO): -ID 67-9 g <br /> -�CC <br /> PRIMARY CONTACT: ❑OWNER iONTRACTOR D OTHER(Please Specify) ff ttVv i <br /> CONTACT NAME: <br /> LTJ CONTACT PHONE: i 26 25c055D <br /> �J CONTACT EMAIL: r i` _„a i Lk - i ' .Co <br /> BUILDING'-'PERMIT`APPLICATIONr ''- __ <br /> Existin• Use of Bulidin <br /> Contract Price of Work:$ • # "— <br /> Proposed Use of Buildin <br /> Bu{Idir�. Type: ❑5FR-petached ❑fiF€t-Attached Neat Source: ❑Gas MI lectric DOther <br /> i. <br /> ❑Duplrsx Qlvluiti-Family-#of Units. <br /> T pe of Project: ❑New ❑Commercial ❑Industrial <br /> j�- ❑Addition -~~-- <br /> ❑Remodel ❑Repair ❑T I ❑SLn OS•rinkier ❑Demolition ®Chant e of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> MECHANICAL-PERMIT APPLICATION <br /> PLUMBING PERMIT <br /> :APPLICATION of Project: New ';APPL.ICATIQN <br /> Addn _Alteration Repair <br /> #of — TYAe of Project: New _gddn _Alteration _Repair <br /> eta fart — 11s-t_atfxtutBs_ ___. #of #of <br /> F7 Biles—_List aCFJxtures- ._-. Llai ofFtxture _ #of <br /> Fixtures <br /> .. <br /> MN <br /> AIC–Air Handling Urtica Heat Pump? Fixtures <br /> Forced Air Systems Toilet Dackilow Prevenier(inside 13td ) <br /> 11.111 Unit HaaterMN gathtub <br /> Gas Piping <br /> Boiler �Urinal. <br /> Water Heater L avaiory(Wash Basin) Drinking Fountain <br /> alall NMI Gas Fireplace Refrigeration Shower <br /> Wraod Stove Floor Drain <br /> MN Gas Ran.e Kitchen Sink&Dis.osai 11111111111 <br /> MN Clc:t Ra Oster Hookups Ducting Dishwasher <br /> Ocher: Medi Drains <br /> Ran e Flood <br /> Cloches WasherMEM Medical Gas <br /> Exhaust Fan Uther, <br /> mon Sink(ServiceiBarftvio,tetc.)� `jther: <br /> MINI <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads an <br /> ACKNOWLEDGEMENT;i have reviewed this application and confirm the information contained herein Is true and correct. Work done pursuant to this permit mustiy h <br /> current federal,stale,and local law. The granting of a permit only authorizes a <br /> Building Official before being authorized under any circumstance./am the ow err or em authorized byoved work and no ditheations owneer of this properly to perform he work forDeviations must first be authorzwhiin writing ch application is made, <br /> and/comply with the State Contractors Law 78.27 RCW and 296.200A WAC. <br /> Oily of Everett Official Use Only <br /> %, .A iga.� ',12411; iYi Y. PENT T# <br /> Cw,er/Authorized Age . — �� <br /> 9 Signature Date <br /> • (Revised 9i23i2096) <br />