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4reETT PERMIT APPLICATION
<br /> BUILDING /.CHANICAL / PLUMBING / SIGN / S1lik INKLER I DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: .J 5/33 7-4/0'40 /lye PROPERTY TAX#: /Zqg 77g3opj 6,27.2.
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:i(7�`J,0L irw,/,,, j/J iel'f.(1/942fr7TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ,3 33 7/q ,09 /:)//e. -
<br /> CITY /// & L STATE //(%,t4 ZIP -7,,q2....0/
<br /> OWNER PHONE: 7(-p__} OWNER EMAIL: � 2'91/2.�4a2
<br /> CONTRACTOR NAME: A,Ej^/ e0.73,-,,,,,,,,„, (-A,f,- ie,,- jj 7)
<br /> CONTRACTOR ADDRESS: STREET 7i'fY� w od4,7,2 !Ave. - 4 , o 2.(241-
<br /> i
<br /> CITY SP/f1 e STATE l 9' �
<br /> ZIP �
<br /> CONTRACTOR PHONE: e2. . - , ,Z__ -70, / CONTRACTOR EMAIL:fa71-0[r OC—a/ , Cp,
<br /> CONTRACTOR LICENSE#(REQUIRED): ''& / 0 67_ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): VV-2,5
<br /> PRIMARY CONTACT: ❑ OWNER 0 CONTRACTOR ®OTHER(Please Specify)
<br /> CONTACT NAME: Own O� CONTACT PHONE: 925— 3915-9,925
<br /> /"® ifh
<br /> CONTACT EMAIL: ..17.70/0p�S-�*S,7
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work: $
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR�gttached ID Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New EAddition QRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler EDemolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ,4 ��r /72eX� `� + '77' /I/BGt1 3DD s/ =5:4,,,, 4f&e
<br /> 74-, a&ovhe9'eA/ 7 GJY 9'9 ve• ,j/efti , g ft T4/%G 705 s f move exo/ g4' e_
<br /> '7Ck 7 81 a p . /00,4.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New X Addn X Alteration Repair Type of Project: New )(Addn Alteration Repair
<br /> #of #of
<br /> List of Fixtures #of List of Fixtures #of List of Fixtures List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump r f Toilet _Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater / Bathtub Urinal
<br /> Gas Piping Boiler ] 3 Lavatory(Wash Basin) _Drinking Fountain
<br /> f Water Heater Refrigeration 3 /- _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 /> i /p Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/ SUPPRESSION SYSTEM _
<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 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 /> PERMIT#
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<br /> 0� 1/, !, til(P D9- ®DZ 4-
<br /> OwnerjAut
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<br /> Si �e Date (Revised
<br /> Agent9 5/20/2016)
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