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PERMIT APPLICATIO
<br /> 4:77 BUILDIN ECHANICAL/ PLUMBING /SIGN IOPPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT It :INFORMATION' ,;
<br /> PROJECT SITE ADDRESS: /311 pop jail., �,_B PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision! L,J(bst�/ Lot No. (attach copy of long legal description)
<br /> 'CONTACT INFO,RMATI,ON ' "; , ''
<br /> OWNER NAME: � G � & Z � TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: TREET - - - 'Po. x l5 7
<br /> CITv ,��t�2�/�J�C�[/l� STATE �A-' ZIP g 3c�` D/
<br /> OWNER PHONE: j K 4 ,55,'9ccd a,5poL OWNER EMAIL:
<br /> CONTRACTORNAME;.....,. .,.-...���-�- �._ :0, -_...,...,.,..,,...._....�.. ....w._....,._._.,.,�_........................:.....v.......„ .-._......m..._..,..._...-...
<br /> CONTRACTOR ADDRESS: STREET 5 Z f GianaC dot
<br /> CITY 5JZ',Q, STATE 1,3A���� zip q�a®1
<br /> CONTRACTOR PHONE: c.:7264,- 1/9 oiR73 CONTRACTOR EMAIL: 3csd k ae..63/r aj
<br /> CONTRACTOR LICENSE#(REQUIRED) (il enixgz5or CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)• D5� r
<br /> ,� ..a ._.. W....,,.. .—,...,.,4,�M
<br /> PRIMARY CONTACT: OWNER ❑CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NA CONTACT PHONE: Oto.- `7 f�O V.3a
<br /> �� CONTACT EMAIL:
<br /> V.i.,.r ,tl,, . > .. BUILDING PERMIT A. PLICATION,y. rt. Z i. t.w ;l x t41; ;. '.,irk.'
<br /> Existing Use of Building: Contract Price of Work:$ /3 `
<br /> Proposed Use of Building: Heat Source: 4Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: El New ❑Addition El Remodel filiepair ❑T.I. ❑Sign El Sprinkler CI Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ga•D + 666(5 çCJLFOLC2 `f ii2 pLO Ce_ irl e `�
<br /> 1
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> M
<br /> ECHANICAL”PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: New _ Addn _Alteration ZrZepair 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 /> I 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 /> r, : . SP.11061404":500,00101.40100::''
<br /> I 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 ci mstance.I am the owner,or!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 and 296.200A WAC.
<br /> f% City o1f Everett Officiaiari,....l Use Only
<br /> 4 ' 0,....,„
<br /> / j PERMIT
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<br /> Owne Au or e gent Signature Date (Revised 10 12/2015)
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