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PERMIT APPLICATION
<br /> BUILDING/ MECHANICAL/ PLUMBING I SIGN /SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> ...7 .7-,
<br /> 3200 CEDAR STREET.EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 i(E)everetteps@everettwagov 1 wywv.everettwa.goutpermits
<br /> (BE Black BlacR loft Only Pae) ,08:01E,OT SiftEpOlpORMATION
<br /> PROJECT SITE ADDRESS: 13,,, (0,,g„›*a" 1-)L, ..,,,c PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION,
<br /> OWNER NAME: :57,),-..,...,v, 1 ca,i yA5 rAJT\ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ‘''..A. (“9(:) -+',.-..c>\.., w.5 c
<br /> STATE LA) n
<br /> OWNER PHONE: Li).5-- (67 - O,-, 9 OWNER EMAIL: 7?///
<br /> CONTRACTOR NAME: AAA./ e /t3r1c....i ., C.(:-.(----
<br /> CONTRACTOR ADDRESS: sTREET 1 3751.1. 1 ‘ A ‘„, 0 ti-t- Yve,
<br /> CffYnit n n i -40--, STATEt,A,y.)- zp
<br /> CONTRACTOR PHONE: Li S -'''-i)if- "Stt-, .. g'S(-15 CONTRACTOR EMAIL: AltAi locn+IAL-cio-f-k ..;
<br /> CONTRACTOR LICENSE#iREOUIRED1i,,Aiiiii13 lc)T i3 t.. 655'P14 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED}: :S 71 3 Li
<br /> PRIMARY CONTACT: F,,OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: i-1 _S-, , C, 7.
<br /> -,--
<br /> J Lk,leN '''tZ-.. \r*:,...-Irl CONTACT EMAIL: /1,1 il.
<br /> •
<br /> autLoitt~iiiirr APPLICATION :,,'
<br /> Existing Use of Building: ' - ',IIIIIIIIIIIIIIIIIIIIIContract Price of Work:$ l Co
<br /> Proposed Use of Building: Heat Source: ZGas DElectric 00ther
<br /> Building Type: DSFR-Detached CISFR-Attached ODuclex DMulti-Family-#of Units: OCommercial Olndustrial
<br /> Type of Project, DNew OAddition DRemodel DRepair DT.I. OSign OSprinkler DDemolition OChange of Use
<br /> DESCRIPTION OF WORK:
<br /> 1.- e.rtki,c_. L-to j ,A...1 ,,, r,--1 .."c_s (...4,\.3cr------1 ,...„---ref- t,,/ pi e
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANI4AL PERMIT APPLICATION ' ' '' ' PLUMBING PERMIT APPLICATION '
<br /> Type of Project: / New Addn Alteration _ Repair Type of Project: _New Addn Alteration Repair
<br /> #of #of #of #of
<br /> List of Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub ,Urinal
<br /> ,
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> I Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove - Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> Exhaust Fan Sink(Service/Bar/Moptetct Other:
<br /> SPRINKLER i SUPPRESSION SYSTEM
<br /> Chemical or Water I No.of Heads ‘ .
<br /> ACKNOWLEDGEMENT.i have reviewed this application and confirm the Information contained herein is true and correct Work done pursuant to this permit must comply with
<br /> current federal,state,and local law The granting of a parmit 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 I am authorized by the owner of this property to perform the work for which application 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 /> PERMIT#1
<br /> 14 i 7(Z, - ci L
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