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PERMIT APPLICATION
<br /> BUILDINECHANICAL/ PLUMBING / SIGN mRINKLER/ 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.gov/permits
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<br /> PROJECT SITE ADDRESS: .3S-vs- // / ACJ Ave 'PROPERTY TAX#: OOL‘''''. 36 0000 - -� ,
<br /> LEGAL for new construction: Short Plat/subdivision ,( /� I Lot No. Os (attach copy of long legal description)
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<br /> �.�:Aii. i�..�S � SP"i . :. CONTACT INF�ORMATIO iaaig.., ��. .,r , .,sw�Z ,,::;z ...�.� � „
<br /> OWNER NAME: 4-6 yyj e, 1 e.S 1_1_6_ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET /() // / goa- s-/-.5. --
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<br /> CITY
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<br /> OWNER PHONE: 1125- qQ 3- C7 OWNER EMAIL: a-c-me-f6 i/'ic- G7 ff yYt ezf (//�Cv)41
<br /> CONTRACTOR NAME: / 4p 40,7e 5 L 4,6.--
<br /> CONTRACTOR
<br /> 6iCONTRACTOR ADDRESS: STREET J D,1/ / g,0'" 5 — SE
<br /> CITY Sne,I_ohi t rj h STATE W/"J ZIP 9 ga` ,‘
<br /> CONTRACTOR PHONE: 42,..c-9C3—02-e?a-- CONTRACTOR EMAIL: -Pne-,q ^I L_f a_ iv 5)1/Ci14(mil
<br /> CONTRACTOR LICENSE#(REQUIRED): � E- 47 3/3'7" CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0�/9g 6c,
<br /> PRIMARY CONTACT: OWNER 'CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME::^ CONTACT PHONE: Lk F ti 03_0 .c�f
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<br /> Oo S, 5e"'.i-oc`cf b e - r, CONTACT EMAIL: c7.G4,6e_c -1rc, cc c,_ cm0:,km(0r4%
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<br /> ,��,�, � �,.. . �.rBU1.�h��ING PERMIT„Ap�'�w C�.�T�ON��,._ ., �. � ,�� ..,,.. , �.;,�a�,.....�, ,,. .x..��.�
<br /> Existing Use of Building: 1 ' Contract Price of pork:$
<br /> Proposed Use of B ilding: `j Li7
<br /> Heat Source: Gas ❑Electric ❑Other
<br /> Building Type: 70SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project:,'New ❑Addition ❑Remodel ❑Repair ❑T.I. , ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: g
<br /> �a C`S -GA-- re- --.' s%x14e. �`lc c s i cte_-rvC.e_.,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT API' IGATION ,_, Z#T, MW1N7O,tt MITrA P t*tt _ ;,, ,_ _.
<br /> Type of Project:,New _ Addn _Alteration _Repair 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 Fix`t�res Fixtures
<br /> A/C-Air Handling Units / Heat Pump 4f” Toilet Backflow Preventer(Inside Bldg)
<br /> /- Forced Air Systems Unit Heater Bathtub Urinal
<br /> �fGas Piping Boiler tp Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration r 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 r Water Heater Other:
<br /> Exhaust Fan / S'nk(Service/Bar/Mop/etc.) Other:
<br /> SPRIN ER I.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
<br /> PERMIT#
<br /> f �. /s- (1,46IR DO SOwner/ uthorized Agent Signat re I J / doyvzduzjDte (Revised 10/12/2015)
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