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<br /> PERMIT APPLICATION
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN I SPRINKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> „idol r
<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) PRSJECT SITE INFORMATION j
<br /> PROJECT SITE ADDRESS: J e 0 9 tile, 'i T Au we-. Ct/F'KC"Tr- *'., '.C) PROPERTY TAX#: OD9341/6,g-s.4,3 C C 2
<br /> .�uexeri plteT/ G 1-,�/tJ� s O.7'(attach copy of long legal description)
<br /> LEGAL for new construction: Short Plat/subdivision Lot No
<br /> CONTACT INFORMATION
<br /> OWNER NAME: /I(tij He(A)t /i f/P-e)dqes 1.4 C TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS STREET CA�4a'1/ (Cf /p"f d>}, '�A i C&. S/ � 4.4 r I e, J�
<br /> cm, gt..a4.- e � STATE 4'S I . ZIP d 9, (`�-�✓ 1
<br /> OWNER PHONE: 4,fa...�►0).. a e - .-- OWNER EMAIL: f�4 : ;` f4 ti tA)( 9 kRC:�a s ! ' co ll�L
<br /> CONTRACTOR NAME: C 44,7/'t (` k Iit.0 gel-tt' e:. X Of 4'!',6 eFt fa l(4, iC' had57.M1'll,'.,,.r AFC
<br /> CONTRACTOR ADDRESS: STREET <) yi Ca11-4eRn tA.. �T. .sLt'i IT_ C
<br /> p�
<br /> cmr 1 �.� STATE .J .. ^- ZIP 7 6 cam,, .,, ;.
<br /> CONTRACTOR PHONE: ..5..., ,>.. — try g`,. ,.5 CONTRACTOR EMAIL: /"/'I'/ 0, e) $,A., Ate t.1I [I(8 C(/ r, I c:.,4,, :.
<br /> CONTRACTOR LICENSE#(REQUIRED): t 40, f. y CITY OF EVERETT BUSINESS LICENSE#(REQUIIRED):
<br /> PRIMARY CONTACT: ElOWNER 0 CONTRACTOR jg OTHER(Please Specify) Da 4 teiq Pe',eSe 'ri ta; Coe
<br /> CONTACT NAME: ... * CONTACT PHONE: t `, ,�
<br /> / , Its.�'"—�1.� �-,��� "
<br /> > t C !?G? ' ;:� f t 't l :. CONTACT EMAIL: ytyP:e:f`:j ' o/'1 /a + 7T rJ t)Ic iv,rr C ea 14,1
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: /1 f x,Q J f c-; '- Contract Price of Work:$ Zi9d/]MD
<br /> Proposed Use of Building: / 11'4 ,.:J :1 ,. Heat Source: XGas XElectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex j Multi-Family-#of Units: .'2(, I4Commercial ❑Industrial
<br /> Type of Project: ❑New DAddition ERemodel i_]Repair DTI. ❑Sign' ❑Spririkler idtDemolition ❑Change of Use
<br /> DESCRIPTION OF WORK:yy h -
<br /> ?'K e YL e 0 t1 A f , 1 de e /.,s' , ,s?G._'.- �C t, , - `; ,�,. .�
<br /> -�-�--t: e+ e�r�e s,cJ
<br /> et,..it / `, _G vtfe a
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): / �r �f'� �
<br /> MECHANICAL PERMIT APPLICATION . PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New Addn _Alteration Repair Type of Project: _New _Addn Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #°f 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 /> 1 SPRINKLER/ SUPPRESSION SYSTEM
<br /> Chemical or Water 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 roust 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 : . •orized by the owner of this property to perform the work for which application is made,
<br /> and I comply with the Statv Contractor Law 18.27 RCW and 296 200A WAC. I2 7/?
<br /> /�. , ., t 4fl / hL..� ( S't/y City of Everett Official Use Only
<br /> 93y/dr5iKs) VsYtatiwy/s-;is HcAKbrf \ ra 1�"f PERMIT#
<br /> 0, ner/Authorized Agent Sig\ ID Nrit.77-t �/ Date (Revised 9/23/2016) �'
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