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OLT PERMIT APPLICATION
<br /> BUILDING /MECHANICAL/PLUMBING/SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES DOoinm,3200 CEDAR STREET,EVERETT,WA 98201 �(P)425 257 8810 FAX 425 257 8857 1(E)everetteps@everettwa.gov www everettwa gov/perm
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<br /> PROJECT SITE ADDRESSIttO Bait PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision 1."4) Lot No. (attach copy of long legal description)
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<br /> V M _�' .�_«� r ,.. „- _ rCONTACT'MFORMAtiStiy —f. W , M_My
<br /> OWNER NAME: j (/)/ 4 \ (, n, ')/14,��'j �{ L. TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET Oc.� � yG��-A- I�� >> p���
<br /> CITY �C�✓ L✓I�_I STATE PfZIP I S 2 3
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<br /> OWNER PHONE: 1 tri a a b, ' 'S-t-,--161 OWNER EMAIL: , t
<br /> CONTRACTOR NAME: fIo rt„
<br /> CONTRACTOR ADDRESS: STREETI 1 k k.--02., tZ/O ”' AJ
<br /> CITY f' Cr STATE V1.14 ZIP 501'/
<br /> CONTRACTOR PHONE: 1.-F/A:qlq • 1 t, ?, 1 CONTRACTOR EMAIL: vL
<br /> CONTRACTOR LICENSE#(REQUIRED):i511--Li£.r- ' %7141/4 ` CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Oc-2.
<br /> PRIMARY CONTACT:
<br /> ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: - CONTACT
<br /> PHONE: -,c 1
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<br /> t)(V � ,1 ) k CONTACT EMAIL: — bD
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<br /> Existing Use of Building: Contract Price of Work:$ • .
<br /> Proposed Use of Building: Heat Source: XGas ❑Electric 0 Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex '4 Multi-Family-it of Units: VO ❑Commercial 0 Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ■T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> (if applicable):
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<br /> ASSOCIATED BUILDING PERMIT# a : �'
<br /> gin')MECHA1 1"C ►L PERM1J 400L14#01:4-0!'n ; �;��
<br /> 7�� " �,�il, PLUMBIN PERMIT APPUCA' 1QN,' � ". �,
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<br /> Type of Project: _New _ Addnteration _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 /> NI S,PRINKLEkI P AIQNtkOIAMI OM
<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 yith the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> (. City of Everett Official Use Only
<br /> 0 P / \ GL"'(-( 1 L 1..� PERMIT# �� r �'n
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<br /> Owner/A •razed Agent Signa 4 , Date (Revised 10/12/2015)
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