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PERMIT APPLICATI
<br /> /— BUILD• /MECHANICAL/PLUMBING/SIN SPRINKLER/DEMOLITION
<br /> ;
<br /> 7 CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-267-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> PROJECT SITE ADDRESS: SS" 31 I l Y v\/ 12 1 , PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision 7 Lot No.' (attach copy of long legal description)
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<br /> , WNER NAME: ?ACI.-(--1 G. (Z--kcA el e y- y 2 S TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET t-k 1"a.\ \ � �� G,,�'(,e
<br /> 1"\-1Aki
<br /> CRY
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<br /> � `, 1 STATE �f ,ZIPOLJt G-� I
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<br /> p��{ OWNER EMAIL:
<br /> CONTRACTOR NAME: WP --r co c c — `Ok IAIY\ N n
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<br /> cO ITRACTORADDRESS: STREET (j`1Lk°\ aC__�IN, S'C
<br /> I CITYC.\c,1 :1- -t)\(\,4 \{ / STATE ' ZIP C a ( j,
<br /> ¢ONTRACTOR PHONE: .keo, — O; CONTRACTOR EMAIL: t`\ 'I
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<br /> CONTRACTOR LICENSE#(REQUIRED):\�-s\--CC -pV 1 \ S ke) CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):_C53 11,1 I i
<br /> PRIMARY CONTACT: ❑OWNERT KCONTRACTOR 0 OTHER(Please Specify)
<br /> GON`TACT NAME: �q CONTACT PHONE: '$3 . L ci T - 1 O U V •
<br /> \Vf\S'O� \I "� CONTACT EMAIL:
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<br /> 9xisiing Use of Building: Contract Price of Work:$ g%O.
<br /> Proposed Use of Building: Heat Source: ❑Gas DElectric ❑Other
<br /> duilling Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Typo of Project: New ❑Addition ❑Remodel ❑Repair 01%1. ❑Sign Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF ORK:
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<br /> 1.5(0 30
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> Type of Project: New Addn Alteration _Repair Type of Project: New _Addn y _Alteration _Repair
<br /> I-;#of List of Fixtures #of
<br /> Fixtures List of Fixtures #of List of Fixtures
<br /> #oP List of Fixtures
<br /> Fixtures Fixtures Fixtures
<br /> I A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bl..,
<br /> I Forced Air Systems Unit Heater Bathtub Urinal
<br /> I Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> I Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> 1 I Gas Range Ducting Dishwasher
<br /> Clothes Dryer Hookups Other: Roof Drains
<br /> Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other: I
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> 't� .. ray.N.y' 7 a� {
<br /> �' l)..; � \..:. 4A. : is am 0 * f rS _i+
<br /> - ., tk A�'�.■ � �w 1.I Chemical or Water I \ No.of Heads
<br /> AQKNbWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and correct.Work donepursuant to this
<br /> cu n federal,state,and local law. The grantingof apermit must comply with
<br /> permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the
<br /> Build/ Official before•-ing:authorized under any circumstance.lam the owner,or l am authorized by the owner of this property to perform the work for which application is ma.e,
<br /> and I mply with theA=Contractors Law 18.27 RCW and 296.200A WAC.
<br /> I
<br /> City of Everett Official Use Only
<br /> ///41.......- Ill°
<br /> . S' .. 1-2_,- _02(42
<br /> OWnef/Author)--d Agent !natur: Date
<br /> (Revised 9/23/2016) -7'1;
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