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41ffrr I PERMIT APPLICATION•
<br /> BUILDING / MECHANICAL/ 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 vvww.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) . PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS:LIC:L!2_ 131c.u: L ri.,./-t Z-e--1 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ( 1V"_Gi.(1.4
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<br /> TENANT NAME(If Commercial):
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<br /> OWNER MAILING ADDRESS: STREET /LIC/OZ k.-I Lt..,:',IL 1-73rre5 4- ___,;i1
<br /> CITY 1,--Lie4._it- STATE kjA ZIP %.2
<br /> OWNER PHONE: 41„, 5 -7---.)7) C) 7ef OWNER EMAIL: r)(\.k--Cl q9c-focoAlcasi. G k 1--
<br /> CONTRACTOR NAME: 0 hz.„‹.... Kt- ff-i' , ,..---
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<br /> CONTRACTOR ADDRESS: STREET 32 /17. ---Ll'=-- RI /—
<br /> CITY G. tt...,c # .STATE e//t 4 , ZIP ri 6-2 -, -
<br /> CONTRACTOR PHONE: 7 7--)7_, yei z 6 2c ci CONTRACTOR EMAIL:q itek,s,,, k‘..,.z,__(,-.),,,- ...,,,,,„ 7
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<br /> CONTRACTOR LICENSE#(REQUIRED): :!/-7,i(±,-, L9 : :/3( , CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER 0-CONTRACTOR 0 OTHER(Please Specify)
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<br /> CONTACT NAME: i /. /.' ;,.- I CONTACT PHONE: 26_.
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<br /> _ le 4..-- CONTACT EMAIL(/'0 )( A.,
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<br /> BUILDING PERMIT APPLICATION
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<br /> Existing Use of Building: v ,,..,,,icu,(1,41/ 1 Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: -14.cas 0Electric 00ther
<br /> Building Type: OSFR-Detached OSFR-Attached 0Duplex 0Multi-Family-#of Units: 0Commercial 0Industrial
<br /> Type of Project: CI New 0Addition El R e m o d e I ORepair Oil OSign 0Sprinkler 0Demolition 0Change of Use
<br /> DESCRIPTION OF WORK:
<br /> dip(/' bC)Adtr-Q6ev.k
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn Alteration Repair
<br /> #of #of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures 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 /> 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 /> 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*firm 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
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<br /> . 1 . PERMIT#
<br /> 'ip , i oci -W3
<br /> Owner/Authorized tgent Signature Date (Revised§ 3/2016)
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