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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL I PLUMBING /SIGN/SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 37 Mjj 0 rrK, Atm), PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: )(byJri/L) .E.,06,(e,ff I,LC TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET C(.f D NE Z 5-1-,
<br /> CITY V UA.t:.!/ti,V er STATE 6,614 ZIP q e, .Js
<br /> OWNER PHONE: 7J - )1.4 i'" Z410 OWNER EMAIL: Ntir-1-Lo5 A,r,t, cweyI
<br /> CONTRACTOR NAME: /1/ 1�M I per_ i-f,1 5S
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): 14.�,I SShyvl j13 6,&'7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> J
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR , OTHER(Please Specify) Q(n-�)--C,, 514p-el-if/SW
<br /> CONTACT NAME: CONTACT PHONE: 503_ 5,„„ " r „ 7 f1pZtpp®,
<br /> ir /‘-)etOiS CONTACT EMAIL: 'r1,i` , i-i► Z5 11)Ct.0 i,'; 6 t441
<br /> BUILDING PERMIT APPLICATIO
<br /> Existing Use of Building: Contract Price of Wor,:$ r)rtia,
<br /> Proposed Use of Building: Heat Source: ❑Gas ■Electric ■ether
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: : ommercial GI Industrial
<br /> Type of Project: ❑New ❑Addition El Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use ,
<br /> DESCRIPTION OF WORK: jy jiQ rt,t i&
<br /> I/ r< �tf✓cJl Gd-�tJ L[v1P-51I� (pipe), co,c45° I s yS° y r
<br /> ( ti R& '.L' , leo41-0 Y4`.'ta/5(, -4 '� exp(<` Air Liuta.6 '41644., kxl,A rue' 1'2
<br /> /z''pgpm 4 lr . }.e4 S 4 n(vi "5. I/z, tn./ �rcr te4 e,S �°/1P 6,d` I vl�,Ip)Pt
<br /> ASSOCIATED BUILDIN PERMIT#(if applicable): A" l @ S ` V iWIt�+ x.3/o /SOD 60-14.40' (.} &
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New Addn Alteration Repair
<br /> #of #of List of Fixtures List of Fixtures #°{ List of Fixtures #°f List of Fixtures
<br /> Fixtures 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 /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> 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 Z,Z. Other: A/,(,Piyn ,� 9 Iv/Z i
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) -t? Other: i/' I%Vt&
<br /> SPRINKLER/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 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 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# � Vibe y O`
<br /> t&teA4A-L
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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