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47ETT 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 1 www.everettwa.gov/permits
<br /> krOJEC ;tST 'INFO. MATIOiN' err k ;,k
<br /> PROJECT SITE ADDRESS:77 QN. c.6..\ \._ �`"'� PROPERTY TAX#: QC.-0�w 0 V 04)4)
<br /> LEGAL for new construction: Short Plat/subdivision /ii' 1 Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: -P \ Ui �^ -- TENANT NAME(IfCommercial):
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<br /> OWNER MAILING ADDRESS: STREET '2•AD CP-G�S 12-6
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<br /> CITY / /`e-�� STATE �/�/ / k ZIP (JI,I�C vv 9
<br /> OWNER PHONE: (-- I' '? Q - 3 2'6 OWNER EMAIL: j'/\, I CA - / V 1
<br /> CONTRACTOR NAME: (, (L/V(?
<br /> CONTRACTOR ADDRESS: STREET 7 ( I (.Q 2ic,-•ii^ S ( " i* f
<br /> ' rCITYNA STATE �A A. ZIP 9 ,g'C: Vim3
<br /> CONTRACTOR PHONE: f!�'`j ' t• 1 44:61 CONT,�RAACTOR EMAIL: V\ LO\ UUCONTRACTOR LICENSE#(REQUIRED): ! , A f I A£ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):OST_� U
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> COT T NAME: _
<br /> r—a/iCONTACT PHONE:L f 1 1.---7 (3 LJ
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<br /> CONTACT EMAIL: V CM
<br /> ��.� -- _ ,� - r . =.nx.BUILDING PERMIT APPLICATIO � rfk,-Vzt - A�., "z 2, .
<br /> Existing Use of Building: Contract Price of Work:$ (,,T--) ,1)0
<br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other
<br /> Building Type: ❑SFR-Detached • SFR-Attached X1Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial
<br /> Type of Project: New ❑Additi n ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> °k „M,0401:CALPERMIT�APPLIC"ATIONI,i,'",�}.il iiy"� �ol� tai mi�1�0iM4in .i PLUM I,11 G PERMI�T"'APPLICATIOt1.h,111, '."w
<br /> Type of Project: _New _ Addn J2LAIteration _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 /> 2 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 /> ' SPRINKLERI SUPPRESSION SYSTEM .
<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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> / City of Everett(et (Official Use Only n
<br /> „ , IP ,f O'L oc ( PERMIT#r tit I Ul/ ` 0 �l/
<br /> Owner/Aut.= ed Agent Signature Date (Revised 10/12/2015)
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