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PERMIT APPLICATICm►
<br /> 100.0*
<br /> BUILDINd-) MECHANICAL/ PLUMBING /SIGIJ4RINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> t��j 3�? (P)425-257-8810 I FAX 42+5-257-8857 1(E)everetteps©everettwa.gov I-gm'www.everettwa.gov/permitsi7s�s,�
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<br /> PROJECT SITE ADDRESS: Z5 4/60 jJ ( )G 6 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: S ka 1 d j4' ; e)4 I 6'75 )Cr TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET Pd A;,x s`a 67 .
<br /> CITY zCi-e// STATE tj'%/ ZIP 9-'y_X) 6
<br /> OWNER PHONE: 4/2 s ` .?..,,,,,,7,,,,5-Voe ote,lc OWNER EMAIL
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<br /> CONTRACTOR NAME: 1 W o I Pe P hV yyl b, y 5
<br /> CONTRACTOR ADDRESS: STREET / 7 3 c2) '''7"-y& 5 7' #e
<br /> CITY Mot-) roe-7 STATE 14/A ZIP 9c,27.7
<br /> CONTRACTOR PHONE: 3‘O --, 79C/-'16.2 1 CONTRACTOR EMAIL: -/ti ,./606 OD/I4 p it,Co yr7
<br /> CONTRACTOR LICENSE#(REQUIRED) 4)°4- 4 pi (�3 C� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4 3�L-/�
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<br /> PRIMARY CONTACT: 0 OWNERE✓�CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: etas-_ j 8 7- 2 a..?
<br /> I ice- An n V>?z,,4 M-- CONTACT EMAIL:
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<br /> Existing Use of Building: Contract Price of Work:$ q. --70
<br /> Proposed Use of Building: Heat Source: DGas 0 Electric JOther
<br /> Building Type: I: -Detached CI SFR-Attached 0 Duplex ❑Multi-Family-#of Units: Commercial ❑Industrial
<br /> Type of Project: ahew ['Addition ['Remodel ❑Repair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: �3/p�
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Type of Project: ew _ Addn Alteration _Repair Type of Project: _New _Addn __Alteration _Repair
<br /> #of #of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units —Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> IIMIM Forced Air Systems —Unit Heater Bathtub Urinal
<br /> upm Gas Piping —Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> UM.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:
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<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 lam authorized by the owner of this property to perform the work for which application is made,
<br /> and!comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT#
<br /> ....-.40( . . . „Mi.—,. .. ...„----r>.--'"111.--- /6) jii 0.4 M (CO /0 '''.-0 ? /(
<br /> Owner/Authoriz:, Ag••t ignature Date (Revised 9/23/2016)
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