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(g". PERMIT APPLICATIO
<br /> BUILDI ECHANICAL/ PLUMBING/SIG INKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICE
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 32. lb ,dolt.rt0, At/t''.-- gg2LL PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: A co,t,,.,; C t.:(5.,t ;. ;:-c r TENANT NAME(If Commercial): ,,/,L,, 7,,,,f17 ,f,° 9014,"
<br /> OWNER MAILING ADDRESS: STREET q/i> /tr ,,,' c t! 5/r �w7e>�:r dad
<br /> CITY L-ArrC.e7 +rt,--i'P STATE YP,4-- ZIP -,,rs 6-,'
<br /> OWNER PHONE: ,5 v'? S•y/_zy V OWNER EMAIL: 5ti®tte,T&r op Vic„ c...ri^
<br /> CONTRACTOR NAME: } / Styi.,ib'_
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: Sf23 iY/ 2.--(//0 CONTRACTOR EMAIL: orowl, ° C.OvY')
<br /> CONTRACTOR LICENSE#(REQUIRED): p,f? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: ZrOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: SM
<br /> rsL.--,_ S KO CA,e. CONTACT EMAIL: Sk-by cz-rES
<br /> BUILDING PERMIT APPLICATION
<br /> 80
<br /> Existing Use of Building: r,.�);ca ( Contract Price of Work:$ 9L1( Do
<br /> Proposed Use of Building: v t=ti+'ar✓ Heat Source: Pas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition , REmodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> x-'-6-n:or- ft.(f^- ar)6-I. riot-'(-, hta $,584.'i-G �r) , I74,e1-'11D e`er e /57;x7; 5l4r '
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 41° C8-4" '11) E KfS7 Yrs, '-1gr? SA. r0' rt I'10z-1.
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New .Addn Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC-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 Other:
<br /> Exhaust Fan ink(Service/Bar/Mop/etc.) Other:
<br /> f3Pi-P-..., 5 iii-k,I
<br /> SPRINKLER/SUPPRESSION SYSTEM
<br /> Chemical or Water ' 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 1 comply with the State Contractors Law,18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> j7 CL-G-(1 PE, T# ��
<br /> Owner/Authorized Ag 1 nt ignature Date (Revised 9/23/2016)
<br /> 11
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