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<br /> PERMIT APPLICATION
<br /> BUILDING i MECHANICAL/PLUMBING/SIGN i SIS•INKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> -- --ti - (P)425-257-8810 [ FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (6146or stack Ink Only,Please) • PR JEGT ITB INFO,BIIIIA`PIOII! •-
<br /> PROJECT SiTE ADDRESS: 3 33o Y 14/l PROPERTY TAX#: 00 931 og0/00/DO
<br /> LEGAL for new construction: Short Plat/subdivision Lof No. (attach copy of long legal description)
<br /> .. ..c0iiii.er.II31PoiliviA`Ii to . •. . • -j �...,_ >• . V
<br /> OWNER NAME: 4e' 1 C // `�
<br /> ct�.jfi✓7`14-1 j-•'4--'- TENANT NAME(If Commercial): ; 2.--4
<br /> OWNER MAILING ADDRESS: STREET P..0c e7a 2-Ztt •
<br /> CITY pg-v-e L ! I / STATE "�j�(/j/E,},� ZIP q j ,'�t 3
<br /> OWNER PHONE: 1. " ' 1/51-tm ......."..... ..... ......_.n'OWNER EMAIL:.,..�1 GNA/A/i/ f/'�d K0 dC'Gt` .,. .,.._. ,.. ., ..,,, ._ .,.....,..,...:�
<br /> CONTRACTOR NAME: E U ."C D1.) 6 rwr( (-4C -c_
<br /> CONTRACTOR ADDRESS: STREET 21 24) PA-e,1 F Act l
<br /> CITY Id UM STATE (,,,,a-,- ZIP 6/S2a(
<br /> CONTRACTOR PHONE: 4` 5-2 e 2-/51 iti • 'CONTRACTOR EMAIL: iG #0i1144"w
<br /> REQUIRED
<br /> CONTRACTOR LICENSE#
<br /> ( ). EV 6.5S a>2.2,0 T- ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 6-1 q 5-5
<br /> PRIMARY CONTACT: ❑OWNER ®.CONTRACTOR CI OTHER(Please Specify) -
<br /> CONTACT NAM CONTACT PHONE: t47 5_7,51.w/5/
<br /> / - CONTACT EMAiL: M,11 e m(,{J/G1.c.,„
<br /> .. ._. ..
<br /> • ,.!- Il U1 ING PERlldilT�1P1�,h,ICAT►ON " . "
<br /> Existing Use of Building: fVl/4/1/f -tV'O 1 Contract Price of Work:$ 6500
<br /> Proposed Use of Building: A.I G� Heat Source: Lomas ClElectric ❑Other
<br /> p if �
<br /> Building Type: ❑SFR Detached CISFR Attached ❑Duplex OMuhi Family#of Units: ,I�Commercial ❑industrial
<br /> Type of Project: ❑New DAddition ❑Remodel repair ❑T.I. ❑Sign ❑Sprinkler DDemolition CI Change of Use
<br /> DESCRIPTION OF WORK: y0. t" ile'5/ ,,,� Uitt �cc G� $ ®,�„�,P,�.Q ,
<br /> c A tl £a'(Y9 5 (41)
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):li -
<br /> ` .IVIEC (AN ICAuk1,;P RM1TAPP>L.IcA.TION . • • . . PLUMBING ki.Egitrirt APPLICATION -
<br /> Type of Projecf: New Addn _Alteration /Repair Type of Project: _•New _Addn Alteration Repair
<br /> #of List of Fixtures °f List of Fixtures #of 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 Other:
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> • PlRIINKILIEk i 4iPiptiEpwig4 SYSTBVV1
<br /> )Number of Heads
<br /> ACKNOWLEDGEMENT:l 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,ori am authorized by the owner of this property to perform the work for which application is made,
<br /> and/comply with the State Contractors Law 18.27 ROW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> ..)-0(7)1..---ent SignaturePERMIT#„ ,� .f` 0�
<br /> 1.4
<br /> Dw��er/Author
<br /> izeDate (Revised 5/20/2016)
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