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PERMIT APPLICATION
<br /> BUILDING /MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEMOLITION
<br /> ZCITY 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.everettwa.gov/permits
<br /> (Blue01lWW:a ply Please) KKK PROJECT TE INFORMA ;O .11111a ,`" _1: .i.:1;,:,,, ,filitiatala
<br /> PROJECT SITE ADDRESS: an 5 ebrrxr.d.( )t <A PROPERTY TAX#: ( 1 3 5 a
<br /> LEGAL for new construction: Short Plat/subdivision .,,/ Lot No. (attach copy of long legal description)
<br /> .. M., .. r . .z.CONTACtIN,PORMATION . ,. fry_ . ., ., } .
<br /> OWNER NAME: \MQ.) *r+✓x-N5 - 07 5"7 0 TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDREA4 STREET ) \A1` Irrl DA- 1Vaya )1A, ) -5.))t)1
<br /> 11 �
<br /> CITY q)c_eNr-CA`A STATE 1 J! ZIP (obbl,k
<br /> OWNER PHONE( L�7J1c )\5 a5hb1i, . OWNER EMAIL: CY111 C(1/4_ ""","'-Per c rr ) LLkil
<br /> ARS )tk fl c.1rNan, ca. Se( \C _c
<br /> CONTRACTOR NAME: � ��(-O ��C,
<br /> CONTRACTOR ADDRESS: STREET Q\1 . \ �,iDaFt_ `A 1
<br /> CITY Tot\,\ Q_SSC.' STATE ZIP T3 620)51
<br /> CONTRACTOR PHONE: 4) q\— -)cp,Lp CONTRACTOR EMAIL: 1 =,In a,U) (les Trial f,) r4
<br /> CONTRACTOR LICENSE#(REQUIRED) jjE,3 M Q q a9 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) I4 O jp L
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: C\ CONTACT PHONE:( 334 GA q_t-- 303 toTarCV 1 l� ' C -5 �I^1Q•wl L
<br /> CONTACT EMAIL:+ b r of S I(lo.l to 40 ( .e s Duch C h►corn
<br /> S ; }BUILDING PERMIT,APPL.ICATION `T t '
<br /> 'fi�s�:' ,...uP'+��- �G. ,a>�.. §y�� t1a.lers°„�as..€-�� .. � .. ,u..,, ., a, ..,.;�:, .as ..s&;ntR.. _
<br /> Existing Use of Building: f T
<br /> e t\ d,Y S@ 2� Contract Price of Work:$ t B) DOC
<br /> Proposed Use of Building: CE 1 1 d5)-73 oe Heat Source: 26as ❑Electric ❑Other_
<br /> Building Type: ❑SFR-Detached ❑SFR-Attach ❑Duplex ❑Multi-Family-#of Units: PP'6mmercial ❑Industrial
<br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign CI Sprinkler ODemolitiori CI Change of Use
<br /> DESCRIPTION OF WORKe �o�- ,. ` , � ' 1''C )QC) & -TU /
<br /> l�%lam- �,r U Q_, l
<br /> ��g.s T©nS
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 4 ko11\5
<br /> MECHANICALu PERMIT , PLICATION ',e s ,,,; PLUMBIING PERMIT APPLICATIONµ u
<br /> Type of Project: New Addn 3CAlteration _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 Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> 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 FanSink(Service/Bar/Mop/etc.) Other:
<br /> 4 t . • U, LL\k
<br /> S'PRIN KL SUPPRESSION S oittM n
<br /> Chemical or Water ' No.of Heads
<br /> ACKNOWLEDGEMENT:l 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 /> PERMI
<br /> w er/Authorized AWM/iia,44)
<br /> Date (Revised 9/23/2016)
<br /> (I,1--
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