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OL" 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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Bluei:or Black InkOnlyyPlease) • "..", PROJECT SITE INFORMATION, .
<br /> PROJECT SITE ADDRESS: (ntj O Z Ever 4 Lay PROPERTY TAX#: 3 q acs 150a
<br /> LEGAL for new construction: Short Plat/subdivision Y tot No. (attach copy of long legal description)
<br /> ... CONTACT,INFORMATION, _ _
<br /> OWNER NAME: . 7-, f 'ai,1146ij i Tvit,.. TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET (>• 0 , 31( o n
<br /> CITY 6 I� / Y STATE 1 sJ 4_ ZIP ?go
<br /> OWNER PHONE: (Q- ( j_ ?*-6----5- OWNER EMAIL: edd ej4AbiI (yj /A/Gill
<br /> CONTRACTOR NAME: f)r yf kL P, ,/ 1.6.04/terk c, 1 L- L._CONTRACTOR ADDRESS: l ?;TREET 2 1 t gUti 511 5
<br /> CITY ndtfp0,C STATE W bTT ZIP 40.2,,C)5
<br /> CONTRACTOR PHONE:4?-4.—-317-(i)�g'5 / CONTRACTOR EMAIL: elide_`V��&�_ tlail/4,7
<br /> )I/ /L L, `ate
<br /> CONTRACTOR LICENSE#(REQUIRED): '1-YIl �(4 '775 z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):G 430 53
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: y,, ,e797
<br /> D4k Ude/� CONTACT EMAIL: k +/4' JL 1 cors!
<br /> , :_ ,.BUILDING.PERMIT APPLICATION ...-g,-;06 ,'..:,,,,,,=,,,,,,,:.. .,-,-,,':...,„:,-,i, .,
<br /> Existing Use of Building: Contract Price of Work:$ '7_2 r000
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric( El Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler Xemolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> Defriet07i fico-, Q i'5 `" ` ci i/_/r —✓4 / -
<br /> 7`C Qi �l�l� � /5 l�
<br /> �
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): k A V v
<br /> (# GArc)
<br /> MECHANICAL PERMIT APPLICATION , PLUMBING PERMIT APPLICATION.
<br /> Type of Project: _New Addn Alteration _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 Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> ,.SPRINKLER'I 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 I am authorized by the owner of this property to perform the work for which application is made,
<br /> and I com wj h the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> Y' ., D
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<br /> • • •uthorized Agent I D e (Revise 2016)
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