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<br /> °' PERMIT APPLICATIO
<br /> BUILDII / MECHANICAL/PLUMBING /SIGNWPRINKLER/ DEMOLITION
<br /> CITY OF EVERE I I PERMIT SERVICES
<br /> '.,,M _ 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 /> ..,.Z... PftOJ' 0T'SI1`E`I :4 ,
<br /> PROJECT SITE ADDRESS:/v // PROPERTY TAX#: 0 0-3(`3 c).7 o p nC>
<br /> LEGAL for new construction: Short Plat/subdivision_ ) 7-vx' -/ Lot No. 2 (attach copy of long legal description)
<br /> . ...:.::.::•..f.. !:::.., .. ,::::::,..,.:: _:... .. .,;.:.;'_ _: .i:::4t,.,.•00NTp4T:INFORMATION':'';.,; : .....�.::•a .:';�':; :::,; :. ,..: .
<br /> OWNER NAME:,, )i j jJ,< C vS o c'( (0A,5 T/41 C TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET , O: /gC. ' S'(3 /
<br /> /-//f/ '' /;j jJ, CITYkn � `L G 171- STATE /72 2o ZIP
<br /> OWNER PHONE: ''2 ( 76.• 5).7, . ,.. ..... OWNER EMAIL:1aj//rwC't✓_70/��'c�i�'-1,5L'��C%/0/V -6 ,J1 •((iC)-1
<br /> CONTRACTOR NAME: , ,j767/Z r.-7y7C4L )
<br /> CONTRACTOR ADDRESS: sneer Sj°'F '7 ,.-6a ,/-f
<br /> cm ' STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> r/r C
<br /> CONTRACTOR LICENSE#(REQUIRED):/v 5 s1) ({ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):5 37 6
<br /> PRIMARY CONTACT: AOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 4/2 )- j.14 tt-, S.3
<br /> P/iL; L i5L1 Ss4es CONTACT EMAIL: 663-7o/L4li(', i, r,,,,, , ('/Gi(,' �4/-0//
<br /> .r P._..M:, N --_“ ._ _..._
<br /> 0Ck1T Qwx. .
<br /> Existing Use of Building: �/ /�, Contract Price of Work:$ /(---C`.('C (
<br /> Proposed Use of Building: — /- ,)ce Heat Source. as ,Electric ❑Other
<br /> Building Type: ,I'�SFR-Detached CISFR-Attached ODuplex ❑Multi-Family-#of Units: ClCommercial ❑Industrial '
<br /> Type of Project:>10New ❑Addition DRemodel IRepair DT.I. OSign igSprinkler DDemolition DChange of Use
<br /> DESCRIPTION OF WORK: /,0/ 7, yl L-3C j Al c / - S F
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> i:`:.:- `.iM€CHANIGA. >:PERIZIIT=APPL ICATI:fj;N �',,: :1 •. ;-.•:.::PL:UMBING.PERMIT
<br /> Type of Project: 'New LS Addn Alteration _Repair Type of Project:A 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 r Heat Pump ,j Toilet Backflow Preventer(Inside Bldg)
<br /> 1 Forced Air Systems Unit Heater 2 Bathtub Urinal
<br /> 3,-- Gas Piping Boiler L/ 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 /> i Clothes Dryer Hookups Other: / Clothes Washer Medical Gas
<br /> / Range Hood / Water Heater Other:
<br /> t/ Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> :: ,' SPRINKLER.4 00:0::PRESS'101 S4401.*M::. 2::
<br /> Number 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 1 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 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PE IT# (`
<br /> 0O — 0 \ Li
<br /> ner1Authorize./c ent Sin_ ure Date (Revised 10/12/2015)
<br /> 771
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