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gn" PERMIT APPLICATION
<br /> 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 1(E)everetteps@everettwa.gov I www.everettw i N
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<br /> PROJECT SITE ADDRESS: I i,11, o V Lpll B'/ O PROPERTY TAX#: / I/�L�Zi ��
<br /> LEGAL for new construction: Short Plaat//subdivi[siiooMn-E''[VVLG 1 ��1 JJJUUUc Lot No. (/ t(attachJcopy` r of long legal description)
<br /> CONTACT INFORMATIOI w _
<br /> OWNER NAME: WCI II V J-ti'lTENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET i2,1 t .0( P 2Qttek p
<br /> CITY a✓eJ 44— STATE ZIP 616.74 1
<br /> OWNER PHONE: 425—(-5/15-674 I OWNER EMAIL: Lad\r tibYf„/�I/•'f n, z ii ma11 c
<br /> CONTRACTOR NAME: w„� Fl,a ��/ ` �/
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<br /> CONTRACTOR ADDRESS: STREET 1 ��/jn141 ` e. 4 1
<br /> CITY �/,f T/Vral , STATE- ,f ZIP qffy.4-5
<br /> CONTRACTOR PHONE: �1j 5- 11 — U/t CONTRACTOR EMAIL: idd kif2���eMfdr /filre j
<br /> CONTRACTOR LICENSE#(REQUIRED): Liti
<br /> , 1395-01116, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 40
<br /> PRIMARY CONTACT: 0 OWNER 4NCONTRACTOR ❑OTHER(Please Specify)
<br /> CC'ml'Ar'T"'^.ME: CONTACT PHONE: Lir--11/ --1134
<br /> rl_ V t,I / /, CONTACT EMAIL: }� � n ,t'�
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<br /> Existing Use of Building: Contract Price of Work: . \` Q
<br /> Proposed Use of Building: Heat Source: ❑Gas m Electric ❑Othe._
<br /> Building Type: R-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: El New <11ddition ❑Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTIONO WORK:
<br /> \NI a livid rIace Ovoner oof an a irokti1
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> hMEOA_NICM! Op. 0 �101"0x „srtis; r10, 0e1100-#0#190*070001100 °+"
<br /> Type of Project: New Addn
<br /> _Alteration _Repair Type of Project: _New Addn Alteration _Repair
<br /> #ofList of Fixtures # List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC-Air Handling Units 1 Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> r Forced Air Systems Unit Heater Bathtub Urinal
<br /> 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 /> ?SPRINKLER;I SUPPRESSION SY.STEIV� 3 #„”
<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.1 am the owner,or lam 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 /> �/J(� Q City of Everett Official Use Only
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<br /> I II// i( IU PER2O ` '' °CACI
<br /> Owner/A {,•Agent Signature Date (Revised 10/12/2015)
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