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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/ PLUMBING/SIGN /SPRINKLER I DEMOLITION
<br /> tolikve,--": CITY OF EVERETT PERMIT SERVICES
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<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 f FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> tillue*or.Black Ink Only 19.0240) 1:::1,1:,:f:-;:-.,,PROJECTSITROIERRIV:IRTORA,) ,'><<i&J;
<br /> PROJECT SITE ADDRESS: 14,1U4 . tit t...3J pg PROPERTY TAX ft:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> OWNER NAME: fiateitcl tz 1 1 TENANT NAME(If COMOlerlielY
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<br /> OWNER MAILING ADDRESS: STREET lig Z4* ALKI DR
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<br /> STATE L4.9 Pi
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<br /> OWNER PHONE: ) 555 Cit540, ,OWNER EMAIL:
<br /> CONTRACTOR NAME cin 3ect.11.tn n-c.
<br /> CONTRACTOR ADDRESS* STREET lq, Brocodt110 ,‘i
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<br /> STATE WA- ZIP *I.Zi- Li.L1 1
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<br /> CONTRACTOR PHONE• 14.4. Z,:^0‘1, 0.7*Q-0t) CONTRACTOR 'amm." a Oh n .c ..
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<br /> CONTRACTOR LICENSE#04BOUIRED)tiVi ocivq4+.''--,
<br /> CITY OF EVERETT BUSINESS LICENSE*RECtifIRED): o ,,qg
<br /> PRIMARY CONTACT: 0 OWNER kfCONTRACTOR 0 OTHER(Please Specify)..
<br /> CONTACT
<br /> CONTACT NAME: CONTACT PHONE* 47'
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<br /> CONTACT EMAIL:..d
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<br /> BUILDING PERMIT APPLICATION-
<br /> Existing Use of Building: . _Contract Price of Work:$ .30.00
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<br /> proposed'Use of Building: ' 4.4
<br /> Heat Source: EIGas isiCtrip 4,,,A9therr
<br /> Building Type, SFR Detached CI SFR Attached OD lex LiMulti-Family-#of Units: OCommerclai Olndustrial
<br /> Type of PN:ileGt: El New ['Addition ['Remodel ORtvair OT.I, DSign •[iSpritikier ['Demolition [::]Change of Use
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<br /> DESCRIPTION OF WORK: ,,
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<br /> ASSOCIATED BUILDING PERMIT It(if attitittnnt0"
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<br /> MECHANICAL4ERMIT'APPLICATIOR ',`, ,\,':',.:•;:', '-,p4uivispie,PERMIT APPLICATION
<br /> ype of Project: New Addn Alteration Repair ' Type of Project: _New Addn Alteration Repair
<br /> #of #of #of #of
<br /> Fixtures Fixtures Fiurea List of Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures
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<br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> I Forced Air Systems Unit Heater \Bathtub • „Urinal
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<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> ' Gas Fire'lace ' Wood Stove Fathom Sink 4tt Disposal Grease Trap
<br /> Gas Range Ducting Dishwasher „Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
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<br /> Range Hood Water Heater • Other:
<br /> Exhaust Fan Sink(SonvtoonlaniNfopfeto,) Other
<br /> SPRINKLER!SUPPRESSION SYSTEM '' ''',
<br /> IChemical or Water
<br /> i IN°.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 end 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!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 298.200A WAC,
<br /> •City of Everett Official Use Only _
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<br /> PERMIT r2#
<br /> T 16. . -7
<br /> Ow /Authorized Agegnature Dat (Revised
<br /> 206):
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