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PERMIT APPLICATIC41
<br /> BUILDIN I itilECHANICAL/PLUMBING /SIGI—PRINKLER/ DEMOLITION
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<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.gov1,ewVw.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: 457)5 410 p y3 Pk C e PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: $kp i-dig. / Re)4 / 675 74,/ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET Po Iit,x Sa t 7
<br /> CITYc,:el/ STATE : ZIP 9'y_ O
<br /> OWNER PHONE: 99,2 S - ,5" oil le OWNER EMAIL: •
<br /> CONTRACTOR NAME: (Wo / �-e P lurk.)
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<br /> CONTRACTOR ADDRESS: STREET / ' 3 .2) '4"7")/a 5 A7,6
<br /> CITY mon rOE STATE W A ZIP 9g,7,2
<br /> CONTRACTOR PHONE: 3 4"(3 794/1t / CONTRACTOR EMAIL: 717 %/60 d IUD/l`L'P it-co/Yi
<br /> CONTRACTOR LICENSE#(REQUIRED): 004 & p (j 3 6..3-- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): d 3 G�
<br /> PRIMARY CONTACT: ❑OWNER C✓J CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: /J CONTACT PHONE: ei.,5-- ..?..2
<br /> _ 3 s• �, 7 q
<br /> l rk /4l,n V!'i Z/Y4�i - CONTACT EMAIL:
<br /> Existing Use of Building: Contract Price of Work:$ .717-1--q.0 L 7 6
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric�Other
<br /> Building Type: ❑SF -Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial
<br /> Type of Project: Mr4ew DAddition ❑Remodel ID Repair 01-.I. ❑Sign El Sprinkler ❑Demolition 1:3 Change of Use
<br /> DESCRIPTION OF WORK: / /
<br /> /i'G>✓G i�y► 9O-5 c ( ; S 1�oil b c, l G i'J 5 .2 )3i� Gcg-e.;S ��
<br /> ./ 149 of ✓ i �.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): J / ��/✓ `,r�/
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<br /> '...'`; MEGHANLCAL`PERMIT APPLI A?ION ,.,.}_.> ....VI nage,..::\PLUMRI!+IG PERMIT APPt ICAT ON0 ..::.. .. .::..
<br /> Type of Project: f New Addn Alteration _Repair Type of Project: New _Addn _Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°{ List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) _
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> 0 i 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 /> S 1001 ;0;k0:40:0.#70..#10104. TY-0.00,
<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.lam the owner,or!am authorized by the owner of this property to perform the work for which application is made,
<br /> and l comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PER IT#
<br /> `o o�� i ./ - Dolts
<br /> Owner/Authoriz Ag••t ignature i Date (Revised 9/23/2016)
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