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PERMIT APPLICATI
<br /> BUiLE /MECHANICAL I PLUMBING /SIG SPRINKLER/ DEMOLITION
<br /> .4 CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 J FAX 425-257-8857 J(E)everetteps@everettwa.gov J www.everettwa.gov/permits
<br /> PROJECT SITE ADDRESS S l f ��) `� PROPERTY TAX#:- ,C r.. '
<br /> k oc.�� �� 7or.)/D/FCC -)
<br /> LEGAL for new construction: Short Plat/subdivision ----S---- /7- ()()/ Lot No. / (attach copy of long legal description)
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<br /> ' �.: ,.� •'!•�,: !�' ::(�O TA•I�"F,INIF'ORIVIA.:1'ONi:: �r'� :.,�; ,
<br /> OWNER NAME:- 1ST/7.14.i.)C0+...3 i/"f ecv-3l7)L'%7L+ii/ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: sTREET . () , +� ��Al.1
<br /> /1/3-/< /_(1i/,L 5 CRY L-c..2l11-. STATE 4A:9,)Y ZIP
<br /> OWNER PHONE: it..21 SSA 7 6 " L,Sir// OWNER EMAIL:.C��.'ii>7�Zt1 t t,jr `CC%�(:ST/1 u("%O,`v r',6/04L
<br /> CONTRACTOR NAME: 81) j7t`4.6 C.,:7-Qi q_
<br /> CONTRACTOR ADDRESS: STREET Ps v, e�✓j 0X AA"/ 3
<br /> f'LJ yS VZLi`i CITY (.. 7/ STATE /92151;277 ZIP
<br /> CONTRACTOR PHONE: G/ S-- 876 6 sl-/ CONTRACTOR EMAIL:442.5 _ 1C-()57-0/"1l(j�J�/2 UC)7G 6;j
<br /> CONTRACTOR LICENSE#(REQUiRED): %51(,1,f7/1 (- ) 1 1 C CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 5 jJJ
<br /> PRIMARY CONTACT: ❑OWNER XCONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: 4 CONTACT PHONE: xio S- -U 7f- (. _r�
<br /> 1)A 4 - A1.1_`_'711 ZL� CONTACT EMAIL�C!�-7/412.)c-c%j`c✓yC'vtis%'/1 L07c ://644///
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<br /> Existing Use of Building: .- • Contract Price of Work:$ . Ci(), Ci(i(_7-
<br /> Proposed Use of Building: J /-,/ , Heat Source: DGas ' Electric 0 Other
<br /> Building Type: jSFR-Detached DSFR-Attached @Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial •
<br /> Type of Project: Mew C7Addition DRemodel DRepair DT.I. DSign ,Sprinkler ODemofition DChange of Use
<br /> DESCRIPTION OF WORK: C V./,0-y^ J - ^i (.....1 S` ')
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .r • :'�'iii:t HAt.1'CA P,E tISI11T=AP.FL`�1'C4f,rite,# .. P.LC MB'ING•PE RM17•AP1�UCATIO•N
<br /> 5
<br /> Type of Project: ,d,New Addn _Alteration Repair Type of Project: New •_Addn Alteration Repair
<br /> Fixtures List of Fixtures Fixtures List of Fixtures Fof S List of Fixtures Fixtures List of Fixtures
<br /> xtNC-Air Handling Units Heat Pump 'j Toilet Backflow Preventer(inside Bldg)
<br /> r Forced Air Systems Unit Heater e:c, Bathtub ' Urinal
<br /> 5 Gas Piping Boiler if 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 /> 1 Clothes Dryer Hookups Other: / Clothes Washer Medical Gas
<br /> / Range Hood / Water Heater Other: '
<br /> L/ Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> ,.:;;:g.•;$0;, LNK,1*:; `SIT#.0.*4-11.1*Y'STEM;,.:,.,;:::.•s
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT:1 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 1 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 /> PE MIT#
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<br /> OS'`irner/Authorized Agent Signature Date (Revised 10/12/2015)
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