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grr PERMIT APPLICATION
<br /> BUILDING/ MECHANICAL/ PLUMBING / SIGN /Lii Y tINKLER I 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: i) .5 U --5 /fG` k' PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: C. y/ ? ,/,—C—.5 /7'cf 9 7 ( TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ,2ge27 ,re./C4-d- /q(/6
<br /> cm" 6-1/ 4'E-7 7 STATE Wi'57 ZIP p8/', .(
<br /> OWNER PHONE: 70 y(- 7a - 6 .5--1 OWNER EMAIL: (-9L'y y e0,937",47.6 7@,,i,9 •CD Zr
<br /> CONTRACTOR NAME: r�/P�4/V.Qiyr / civil yC,-/ 37-'Ec11-1�//C ,f�L 27,/,-C
<br /> CONTRACTOR ADDRESS: STREET /?y/p Nwf /(y 5 TE,A -//r o
<br /> cm, GX/J/?//"i1a d STATE 11-- ZIP ( $'D36
<br /> // c
<br /> CONTRACTOR PHONE: ,2Q�p -3 7 - yQ?9 CONTRACTOR EMAIL: 6,,a/37 /{ )1"Pe.,/ 6 '
<br /> CONTRACTOR LICENSE#(REQUIRED): 6,/,X17;7/ /951c L.d CITY OF EVERETT BUSINESS LICENSE#(REO. IRED): 5(4 (23
<br /> PRIMARY CONTACT: ❑OWNER X CONTRACTOR 0 OTHER(Please Specify) f
<br /> CONTACT NAME: /� CONTACT PHONE: 6,1c, '.3p�p -5/ 77
<br /> -1X6----1,d, �1.e.,, T/ .i CONTACT EMAIL: ?7l4.4/44 Kg. G',4,�YY�jyrd,-? //74/47
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ i2 5 c:\ 00 O
<br /> Proposed Use of Building: Heat Source: ❑Gas DElectric }
<br /> ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex Multi-Family-#of Units: /0 El Commercial ❑Industrial
<br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: .—
<br /> _
<br /> � 24� ��,a -e . -1:1.,/, .5 i. c,2- TrWA41 C's S 1-/al r ti" 'X
<br /> / t F/6,916i4f
<br /> ASSOCIATED BUILDING PERMIT it(if applicable): / S O, 626,0/5'2-// - r-1') e( f '-v��`-rtr.-e07_,
<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 #°f 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 /> ,a. Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher .'..,D sins
<br /> Clothes Dryer Hookups Other: lothes Washer 1a) w'-�`�=ttri -/
<br /> Range Hood Water Heater Other.
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) ": g
<br /> SPRINKLER/SUPPRESSION SYSTEM Qr. ?6, 2017
<br /> Chemical or Water I No. of Heads Per OF
<br /> E��n
<br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to g dsticomply 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 authorize n 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 -w 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
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<br /> Z-------_ -----
<br /> E MIT#
<br /> x/2©//7 t�n� 3 �o d
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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