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<br /> crs- PERMIT APPLICATI•
<br /> BUILDING / MECHANICAL / PLUMBING / SIGN / SPRINKLER / DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> (60 _ __
<br /> 3200 LCIJH 47EEM J1l" ..titERE i-. v`/,A9820 I
<br /> (P)425-257-8810 I FAX 425-257-8857 j(E)everetteps@everettwa.gov I www.everettwa.govlpermits
<br /> ( M Orlthck fuR OW file age) Illitilitet ette 11001*NFAt1ON
<br /> PROJECT SITE ADDRESS: ./,5'St Ffreee&1t7i/f 1,.E y STD PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> (lOWNER NAME: /7/J
<br /> C F p,,t,9.(.-1 y 41 .,�,si�.•%,,Kz P tENAN T BUSINESS NAME(Commercial):,5� "- eve: I
<br /> OWNER MAILING lADDRESS: STREET /21/1/ ij'iQ h rA AL 1-c/
<br /> �i CITY S 7U/j/G C', /1",/ STATE C 4ZIP 9/�yG V
<br /> .;'/�OWNER PHONE: —Se7S - 6 777 ,OWNER EMAIL:
<br /> CONTRACTOR NAME: Pe)}ram S Si 5i7 .-� L/��i7re`4-f`
<br /> (CONTRACTOR ADDRESS: siRti ,�SA/S.�lk,.4 /9P e s'� t
<br /> CITY Sr 7OAeimi,s6i STATE �v/4/ ZIP 7 g.2- .�
<br /> CONTRACTOR PHONE: V.2 '-iyl-_-%tzs /CONTRACTOR EMAIL: "I /c'.e S. .2 v2 e�f,S4 .. c.-- 101
<br /> CONTRACTOR LICENSE#(REQUIRED):t,-fti",SL S-s-,/i4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): _fa s�..G
<br /> PRIMARY CONTACT: 0 OWNER 9.CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ICONTACT PHONE: t j2 �' y7s_,e,;(/.2
<br /> �5/1/C e ,/f Li'Ara C ICON I AI T EMAIL: pG/://y“. 2,2 er&,...f//' e-e i.--1 i
<br /> AUU.#tmNO INFORMATION
<br /> Existing Use of Building: 5/7d, tc,e-Ai ce7./—e*r Contract Price of Work:$ 2 2. .5O
<br /> Proposed Use of Sodding. 5-i9in c ['heat Source.. ❑Gas DEect is OlOties
<br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex EADU ❑Multi-Family-#Units: Commercial Accessory Structure
<br /> Type of Project: [New ❑Addition ❑Remodel ❑Repair OT.f. Sign OSprinkfer ❑Demofifion ❑Change of Use `
<br /> iJC.ivt.IP i�ION OF INORk:. L1 f e c.4 A e c/. c -.tri",G a &A.-- fit,- zirh„.0 /'Tr'fi
<br /> ,,,,/sievr 6 x,5,'.%t.,y /h env /3ca:d a by ys,r4-/I ♦ti6.w a/,, e cfc-S..,r
<br /> I0 De;ye P4r4- a 97/-, ,s<�/,..'fy// air e OPei""- A,1../ Cal—o/'yv /i
<br /> a-iv7gi"11
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Fixture Fixture Fixture
<br /> List of Fixtures List of Fixtures List of Fixtures ! Fixture I List of Fixtures
<br /> Count Count Count Count In- A/C..:ir H ,dIIi UF,its Ca3 ri irr; r,. .,,d_) 1 Wc,,,,u3
<br /> y ji y "ua���ivvr Ti cvi:t ilCr�,,,J u�vi.uyj vi wvuc f cr��'�N
<br /> Boiler Gas Range Clothes Washer -Sink-Commercial(3-comp,prep,floor)
<br /> .Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bef)
<br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility, laundry, mop
<br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet
<br /> Exhaust Hood(Type I) (N.ot Heat/AC system), Hose Bibb Urinal.
<br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair
<br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter)
<br /> Forced Air Systems Other Medical Gas Water Valves or Fixtures
<br /> - !Gas-rrr'epiace,wserwLuq ; I I iYCuui Enairis iVVdwI nearer- i
<br /> SPRINKLER/SUPPRESSION SYSTEM Sewage Ejector or Sump Pump Other:
<br /> Water Suppression System .No.of Heads r
<br /> •
<br /> Chemical Suppression System 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 /> 3 fj)A472..,e____
<br /> Owner/Authorized Agent Signature Date (Revised 10/10/ 018) !/
<br /> !2
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