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PERMIT APPLICATIO
<br /> '111.PAI -4BUILDIECHANICAL/ PLUMBING /SIGNINKLER/ 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS:i 7 i 6ay,_y 4V,_ k 4).4 9B, 0 j PROPERTY TAX#:oD5 19oo(o0QllOD
<br /> LEGAL for new construction: Short Plat/subdivisi q,33l ocA i' Om yap Am,e__ Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:&ph kf,/e__ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET...?O2... ,/j-' aid)
<br /> CITY r5f 01)47-7/‘44 - 'l STATE EA.)v4 ZIP hJ,29%,
<br /> OWNER PHONE: 1:2$-9„2 3 (oO ) OWNER EMAIL: }/,,g_.0a ho cj-oni je r-„ r)�/4,7
<br /> CONTRACTOR NAME: 0r,c9vl(�f� 7
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: •
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 52.OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTA9T NAME: . CONTACT PHONE: 2,0t ?DO 8/. ..7
<br /> ,. /9c./(4.9,- ?sow CONTACT EMAIL:
<br /> 5IC.G O47k lAr Pm4.424:i
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: �rk ham//�j/-,OS/ (�e/)C_Q__ Contract Price of Work:$ (, '5 i2t�(' ----
<br /> Proposed Use of Building: �jl,w-7,, , 4J,•` te546,,,___ Heat Source: 1Gas ❑Electric ❑Other
<br /> Building Type: $.SFR-Detach OSFR-Atfached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Additionemodel ❑Repaiirr ❑T.l. ❑Sign OSprinkler ❑Demolition/ OChange of Use
<br /> DESCRIPTION OF WORK:/-
<br /> e.." 1„,,�� �,,..� Oil✓_&:_eyo lt6�" c(G/Gd 55__4,,,,,D 5.' () ,j /47,44,,
<br /> a4j he /-4fre-121-1'I fxtserven` eios�e Laundry' 7/ hz,5 ,r,Ot.2- in4,S'1 1&4 /27 dno/;
<br /> aok e. //i et c%o .
<br /> ASSOCIA ED BUILDING PERMIT#(if applicable):
<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 /> NC-Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater I Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> j, Water Heater Refrigeration .2 Shower Floor Drain
<br /> J Gas Fireplace Wood Stove ) Kitchen Sink&Disposal Grease Trap
<br /> I Gas Range Ducting f Dishwasher Roof Drains
<br /> I Clothes Dryer Hookups Other: I Clothes Washer Medical Gas
<br /> ) Range Hood ter--- -• Other:
<br /> 5 Exhaust Fan I Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/SUPPRESSION SYSTEM
<br /> Chemical or Water I No.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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> / r ICiity/off Everett Official Use Only
<br /> �J / /6------- C.,%& PERMIT#W ` D®t� -gy 1_,.
<br /> Owner/Autho zr(ed Agent Signature �/ Date (Revised 9/23/2016)/
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