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PERMIT APPLICATION •
<br /> (47-T BUILDING /IGIECHANICAL/ PLUMBING /SIGN /SPRINKLER/DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: a;20l /et) r• 5 S, /Ai, PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: TENANT NAME(If Commercial): A t) 5'ys-,cYh S
<br /> OWNER MAILING ADDRESS: STREET ;A)( lQ pttl jf-, Jlkv,` ) / `G 4 l ,
<br /> CITY ,/`U„t t,,.�, W STATE H ZIP j y
<br /> OWNER PHONE: i 5 T- 3 7] - I,$Lrr, OWNER EMAIL: ,//�
<br /> CONTRACTOR NAME: de'It('`'-- 'fit-„-tp•{vr1 vt d',,n' / .-r%j(u ,
<br /> CONTRACTOR ADDRESS: STREET L- vti t,,;,,.y {w, j/h/,�.
<br /> CITY `JU��/l : �� f STATE V/% ZIP g L
<br /> CONTRACTOR PHONE: 6,0-e7.3 ,f1 CONTRACTOR EMAIL: 1) o. ) ,,,, i L Ccvt
<br /> y
<br /> CONTRACTOR LICENSE#(REQUIRED): /l101;Dl /C )jSL ii CITY OF EVERETT BUSINESS LICENSE#(REQUI ED):53 5
<br /> PRIMARY CONTACT: ❑OWNER p-CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: .-(,,,'C) - (:,IC,— t') 7. —
<br /> L )9v2 I L-- CONTACT EMAIL: .Ji., e (A.,,,A,.cio 4t 6.;✓l' I, CCU
<br /> BUILDING PERMIT APPLICATION ( �y ��
<br /> Existing Use of Building: /l1 Contract Price of Work: $ WC
<br /> )IL,
<br /> Use of Building: `,./i; Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel 1 Repair ❑T.l. ❑Sign ❑Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: �
<br /> AitC4,t*k. 9 '?--I ,'i't t"- P - - Yt. At x- Lt' ev►C slki2 6'(
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New _ Addn Alteration )ORepair 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 /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems - Unit Heater Bathtub Urinal .
<br /> 1
<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 /> 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 /> PE I�(\� Q 2 On(
<br /> /Authorized Agent Signature Date (Revised 9/23/201
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