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PERM{T APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SfGN/SPRINKLER/DEMOLITION
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<br /> CITY OF EVERETT PERMIT SERVECES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201 �
<br /> (P)425-257-8810 � FAX 425-257-8857 �(E)everetteps@everettwa.gov� www.everettwa.govJpermits I
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<br /> .,,;: P_ROJECT SITE�INFQRMATiON ' �'
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<br /> PROJEC7 SITE ARDRESS:�,� S.� � �`''� PRO Y
<br /> L�GAL for new construction: Short Pla�/subdivision Lot IVo. (aftach copy of long legal description)
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<br /> $ - ' _ ' ' ,;CONTACT IN,FORMATION':` � ,;„, :
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<br /> OWNER NAIVtE. TENANT NAME(If Commerc�al): �('i C. I�[ �r,,
<br /> QWNEf2MAILINGADDRESS: sraeer �-I�S ��+3 �l �
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<br /> �WNER PHONE: OWNER EMAIL:
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<br /> CONTRACTOR NAME: �u Yn ����...,�� i
<br /> CONTRACTOR ADARESS. S7REET � S"/S" �-((yL S�( S'�= !
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<br /> CONTRACTOR PHONE: cr ?�,t9 3 (� CONTRACTOR EMAIL: ��� /� o� /c... �i. co/`'� �
<br /> CONTRACTOR LlCENSE#(REQUIRED): r� �1 G S /"l CITY OF EVERET7 BUSINESS LICENSE#(REQUIR ):Q L 1 Cj �
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<br /> PRIMARY CONTACT: ❑OWNER [�CONTRACTOR ❑OTHER(Pfease Speci#y) ;
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<br /> CONTACT NAME: GONTACT PHONE: LI�f"� 7�� �3`o `
<br /> I t/�� f'Z�e/� CONTACT EMAI�:
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<br /> V,:.= ,..:v , ..._..:. :.,�.; �_�:«. . . .,`, BUILD�NG�PERMfT.APPLIC,AT.ION, . . ._,.,.' ,...�..,:: _. _. .�., .�._=
<br /> Exisfing Use of Building: Contract Price of Wor :$ � SUZ3
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ther
<br /> Buiiding Type: ❑SFR-Detached ❑SFR-Atfached ❑Dupiex ❑Multi-Family�of Units: �C merciai ❑Industria!
<br /> T e of Pro'ect: ❑New ClAddition ❑Remodel ❑Repair ❑T.I. ❑Si n �S rinkler ❑Demoliti ❑Change of Use �
<br /> DESCRIPTION OF WORK: �✓\1 � l� k�'tf�" we,d-�.�' �-Ca�-e./1 LC:i.etn�r S��v�Lc� w4)�-e./ 1`L�.��'-��^-�,_ p�
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<br /> ASSOC(ATED BUILDING PERMIT#(it applicable:
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<br /> ,;:�MECH�1NiCAL pERN[�T APPLICATION.,�„�, ;:: :.;, , ,,_ ,,;; PLUMBING':PERMIT APPLICATION. „,,;
<br /> Type of Project: _New_ Addn Alteration ,ftepair Type of Pro�ect: New Addn Alteration ,_Repair
<br /> #of i�st of Fixtures #�f L�st of Fixtures #of Lrsf of Fixfures �°f List of Fixtures t
<br /> Fixtures Fixtures Fixtures Fi�Kures
<br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bidg)
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<br /> Forced Air Systems Unit Heater Bathtub l}rinal �
<br /> Gas Piping Soiler Lavaiory(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 a
<br /> Clothes D er Hookups Other. Clofhes Washer Medicai Gas �
<br /> Range Hood Water Heater Other: �
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc. Other:
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<br /> :.�.SPRINKLER'`i SU�PRESSION SYST�MF . _ �
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT.�!have reviewed this application and confirm the information confained herein is frue and correct.Work done pursuant to this permit musf comply with
<br /> current federal,state,and/oca!!aw The granting of a permlt onty authorizes approved work and no deviations therefrom.Deviafions must first be authorized In writing from fhe
<br /> Buiiding O�cia!before 6eing aufhorized under any circumstance,i am the owner,or 1 am authorized by the owner of this property fo perform fhe work for which application is made,
<br /> and!comply with fhe Sfafe Contracfors Law 98.27 RCW and 296,200A WAC.
<br /> City of Evereft Official Use Only
<br /> ��—_.. Co_ I c� - � �-- PE �C� -O S Z
<br /> Owner/Authorized Agenf Signature Date (Revised 10/12/2015)
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