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PERMIT APPLICATION—
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> 'IlliiiiiCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 0430 � 0!),,..e 9Y4�V{ .920( PROPERTY TAX#: 001--13/ / (ogic 30D
<br /> LEGAL for new construction: Short Plat/subdivision 6/0,4 rj UI Lot N 93 62Y(attach copy of long legal description)
<br /> CONTACT INFORMATION�„ ;
<br /> OWNER NAME: .1..Jy2 j. -1- �cJ tilDiproth .�v (.j.ji'ir`NT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ç7 / (i,i°r40&_ (_l° /� � /
<br /> CITY ( `ft f.P, - STATE ZIP '/yS }/)I
<br /> OWNER PHONE: 0(0-QC3-�� )6( OWNER EMAIL: ,, e r f k"el ris 0 OU+ C./�G5�
<br /> CONTRACTOR NAME: CAw�s-r161J ,i ` /�[ (O/ �/fV t1G1 r ( -ILa") '<r A117t pi[! alf t
<br /> CONTRACTOR ADDRESS: STREET G � V- �Jr) [C/pjl/ �ry&Il (Thi i' ---5,(„,0 p
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: —
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): D'i44
<br /> PRIMARY CONTACT:TOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME:
<br /> "� ) CONTACT PHONE: Qr-y 0 9(s Off, O'1
<br /> athP/tl�v CJS CONTACT EMAIL: l�7`��`l, r �a_d ® 75` clik,
<br /> BUILDING PERMIT APPLICATI•
<br /> Existing Use of Building: CC nn�p�; �p,A,� Contract Price f f Work:$ �.y Iii '
<br /> Proposed Use of Building: S-F (2,e t( `r✓!'tC Q. Heat Source: 171.'-as $ lectric ❑O •-r
<br /> Building Type: €R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ' ommercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ,epair DTA. OSign ❑Sprinkkller ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: `' t,5 S�„ t�oi � 0\r; t W1 6ot(1, r , Ivo W0/j pr'� V/coo l
<br /> C frVV'-+e r� W( " p'e-' (I'lf+- ±o fo a4,-f- r-hs-lI no co '"a- iNe.,6- .cArt /ice.j,0*'0�'J�
<br /> 1 l 1('t�ftv- 2 1 -2 �D $�" (,?:),r-�' -r.,w. l 9l0 ty i�C�, ®�"/Lt ' 41 t
<br /> `� � � /
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): �4- toJ-a-feok CIC iCC,'Jf _ also(bpd A ml/
<br /> MECHANICAL PERMIT APPLICATII9N PLUMBING PERMIT APPLICATION f -
<br /> Type of Project: _New Addn Alteration 9/Repair;- Type of Project: _New _Addn Alteration 'pair
<br /> #of List of Fixtures #of List,.• fixtures #of List of Fixtures #of 1.' %f Fi, es
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units ,- . 'lump Toilet B ',I,f enter(Inside Bldg)
<br /> Forced Air Systems ,^,n 't Heater Bathtub
<br /> Gas Piping \ `/ ' ' ` Boiler Lavatory(Wash Basin) Inking Fountain
<br /> / Water Heater Refrigeration Shower Floor Drain
<br /> [ Gas Fireplace/, i Wood Stove Kitchen Sink Dis/7 Grease Trap
<br /> Gas R• g- Ducting Dishwasher 117 Roof Drains
<br /> f Clot ,_�1;.,-- Hookups Other: / Clothes a Medical Gas
<br /> 1, .:�JA. od IIS-ef self rGws/VLOther:
<br /> Ex,.;'st Fan Li Sin ice/Bar/Mop/etc.) Other:
<br /> ,--"SPRINKLER l SUPPRESSION SYSTEM I rejtroued &'6izo 1t-4-7 l 1 ��Ai[� 1
<br /> Chemical or Water I No. of Heads L( e I eL 14-,A) v- p j a j r
<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 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.lam 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 /> U-e‘
<br /> &A"-eh
<br /> City of Everett Official Use Only
<br /> PERMIItw goo ...003
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
<br /> OD
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