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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL I PLUMBING I SIGN/SPRINKLER/DEMOLITION
<br /> .111111W1.-.-rCITY OF EVERETT PERMIT SERVICES
<br /> 8200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-2574810 I FAX 425-257-8857 I(E)everebeps©everethva.gov I www
<br /> (Blue or Black Ink Only Please) , ':,,;, ,,, PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: (0 7-0-q-- ' l/tidy Lit PROPERTY TAX#:t25Ci5S i5Li 0 erxigra...0,i
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Airli\L Mt:).Iii C br) TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 0 ((\/ (...fri- ;-
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<br /> eny evrirf, ' STATE A
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<br /> ZIP 9k.21)3111?2 J
<br /> OWNER PHONE: W(/— (0 4—, 0-in OWNER EMAIL: a mi;6 5 le \rain()0 , .0001
<br /> CONTRACTOR NAME: At( CA oem/k.., --T,-;y\c....
<br /> CONTRACTOR ADDRESS: STREET ,.. Is3 C k77...0'. C4
<br /> CITY I .."' WI Dind STATE t.-J • E1R ctri55:
<br /> CONTRACTOR PHONE: 12 ---7441,- 30-4--q--- CONTRACTOR EMAIL: 4 4 (IC If 444+: i
<br /> CONTRACTOR LICENSE#(REQUIRED): ALL( LC4-101,fa C 60 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):an(0 i 2,-2,
<br /> PRIMARY CONTACT; 0 OWNER *ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: 7
<br /> 4)VA % CONTACT PHONE: 44 2.E-T1-q ki- ' ,2 _. —
<br /> nt(AY\tifif,
<br /> r CONTACT EMAIL:
<br /> '' ' , ',•,:-.: B,ViLDINGTERMIT APPL10063,44, 1'----=--. .•
<br /> Existing Use of Building:
<br /> Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: DGas ciElectric DOther
<br /> Building Type: DSFR-Detached ' ER-Attached CiDuplex 0Multi-Family-#of Units: OCommercial Olndustrial
<br /> Type of Project: DNew DAddition emodel DRepair 1:11-.1. 0Sign 08pr-inkier 0Demolition ElChange of Use
<br /> DE RIPTION OF WORK:
<br /> -- 1 4--0 tra V\(
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ' mOtHANIcAL7PERIVittAPPLICATION ,''' : '',,PLUMBING PERMIrAPPLICAtION:
<br /> Type of Project: New Addn Alteration Repair Type of Project: _New Addn Alteration Repair
<br /> #of #of #of #
<br /> Fixtures List of Fixtures Fixtures List of Fixtures s List of Fixtures of
<br /> moms List of Fixtures
<br /> "A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> f 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 8s 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(SerViceil3ariMopietc.) Other:
<br /> SPRINKLER/SOPORESSION.SYST:EM
<br /> ernical or Water I JNQ.of Heads
<br /> ACKNO DEMENT:I have reviewerithis application and confirm the information contained herein is true and Correct.Work done pursuant to this permit must comply with
<br /> current fe,-ral, tate,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• dal,afore b- ,,auth,"ed u er any circumstance.lam the owner,o r I am autltortz,ed by the owner of this property to perform,the work for which application is made,
<br /> and!co • Me State , , tam wi18.27 RCW and 296.200A WAC.
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<br /> FERMI
<br /> tr....lay 0_f Everett Official Use Only
<br /> Yi II I (,Ci 0 1
<br /> if`Owner!. ,tho zed iv,nt Signature Date (Revised 9/23/2016)
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