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OMR
<br /> PERMIT APPLICATION
<br /> "IP* 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 www.everettwa.govipermits
<br /> (Blue or Black Ink Only Please) PROJECT SiTE INFORMATIONy
<br /> PROJECT SITE ADDRESS: ki t 4 e "c ';). PROPERTY TAX#: , J C1
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: y).:` V.° ...2c TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 0 M \,e^r, `
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<br /> CITY - -NC V�''e STATE ZIP C L-j 'IC
<br /> OWNER PHONE: ``atrPd W A/'` '`lNk..:sem OWNER EMAIL: `),+,,;‘,0 Lei,, ,. C ,. "*C. .:a Ay c-... A
<br /> CONTRACTOR NAME m \-e-1/4:414. ' ‹.Lii*C,AAL I (CA-
<br /> CONTRACTOR ADDRESS: STREET
<br /> 1,',..C-4„1/4:7 ti"1 .
<br /> CITY VOLOAA. `3l STATE V th°`°•- ZIP Cifi` -^7
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<br /> CONTRACTOR PHONE: Vit,%kijA!t i 1,-r) CONTRACTOR EMAIL: $.-.40-4.\44'\j<i,. ,✓Q. 43... .' ` :,,.,.C A-Le,
<br /> CONTRACTOR LICENSE#(REQUIRED): ICC1`'t t 0 le,A0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t27,41 3c'
<br /> PRIMARY CONTACT: 0 OWNER PLONTRACTOR 0 OTHER(Please Specify)
<br /> •
<br /> CONTACT NAME: CONTACT PHONE: ,g),,., :3 i "`"13 j 1/40
<br /> ">*4f,i.- . \. kvAdeieS CONTACT EMAIL: _ it.kit `a' . `a.kL lt:.44,t' ,),t.%
<br /> BUILDING PERMIT APPLICA N
<br /> • ,
<br /> Existing Use of Building: Contract Price of Work - —- --- - -
<br /> Proposed Use of Building: Heat Source: OGas 0 Electric 00th:
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: F Commr. cial ❑Industrial
<br /> Type of Project: ONew ❑Addition ❑Remodel Ja iRepair DT.I. ❑Sign OSprinkler ❑Demolition *Change of Use
<br /> DESCRIPTION OF WORK: i
<br /> 1NQ ,,io-`rte- V.iei +.r t 4..?-A.— "11 ti' t' ' d---vk-Q
<br /> ., ,�,.'t., O.. 1L C � v Q, ,A-'t C". 0,...,,A0_ ^ ►� A. K yt i tiL o .°�'t_.
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<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 r R,pair
<br /> #of List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures
<br /> Fixtures
<br /> NC—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 /> 1 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 I SUPPRESSION SYSTEM
<br /> Chemical or Water I 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 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
<br /> Ii - .... i PES ga -- °:. 5
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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