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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL/PLUMBING 1 SIGN I SPRINKLER t DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425,267-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 wbvw.everettvia.govlperrnits
<br /> (Bine or Black Ink-Only Please) PROJECT SITE INIFORMAT
<br /> PROJECT SITE ADDRESS: 3r,3 4. .6.$i vt. i- . °�a oe , ;)�, GI` 2.4 3 "'® -`' •x#: 1 v 23
<br /> LEGAL for new construction: short Plat/subdivision _�__ , Lot No.__,_ (attach copy of • .legal:desption)
<br /> • CONT lGT.INPORMATION,:
<br /> OWNER NAME: se&,,,+i TENANT NAME(If Commercial) _ oc;,.,,1
<br /> OWNER MAILING ADDRESS: sTt asr '%6076 tri. Co-S.%w i. i
<br /> carr iz to • STATEA Ziff ''''! 2 e I
<br /> OWNER PHONE: ..'OWNER EMAIL:
<br /> , CONTRACTOR NAME: 11/4,)(0Jcr$'t A.1 t` s,t ,t.+..,:4."k Cor.4ro.cit0 e r \"c
<br /> CONTRACTOR ADDRESS: smart- it(o ti {at ` ?tact vJe,s-k
<br /> oiTx Alia.t4i t -C e . STATE fl. ZIP 1 4s 2`7 5
<br /> CONTRACTOR PHONE: 29$- 616-q a 9 a CONTRACTOR EMAIL: to r A','irc t"c IA e t3.°tC t . rw o+"%.%
<br /> CONTRACTOR LICENSE#(REQUIRED): I�i Ni ts+k .44` [ t J CITY OF EVERETT BUSINESS LICENSE#(REQUIRED. $ 69-2 to 1
<br /> ... ,.. >.-y-.... -_ . .. . ._ ,
<br /> PRIMARY CONTACT: •WNER ONTRACTOR i�aTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 253 - 1 a - 901-6
<br /> 3rir w NA;i -c tkl CONTACT EMAIL: bi al-.rv. -rt I,1 li 3,ftwC%,cow.
<br /> IBUILDING'PERM1I'APLECA'TION
<br /> Existing Use of ,, t �� a •�., ._. � -. , ,�
<br /> F
<br /> Building: Contract Price of Work::$ \5 c,
<br /> l i I e+
<br /> Proposed Use of Building:- Heat Source =T as (electric =citther
<br /> Building Type: LiFR-Detached .FR-Attached IN•uplex i4' ulti-Family-#of Units: .'k 3ommercial IR dustrial
<br /> Type,of Project: 4% ew [addition 'emodel W :'epair c% .I. Ile.igh Etprinkler lemolition . `, hange of Use
<br /> DESCRIPTION OF WORK:
<br /> ge itte444.: Gyri t,,t c , —sl•+ a i �e� 40'r3 C. '. i ►�► r oggiiirzi:'"
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> '' ,MECHANICAL,PERMIT APPLICATION: . ... PI UMB0G,PERMIT AP#^044:I'1!SN F. , 1.
<br /> Type of Project: New^ Addn Alteration Repair Type of Project: New Addn Alteration Repair
<br /> o #of #of #Of #of
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtures Fixtures F t res Fixtures
<br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater Bathtub .11Urinal
<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 /> ..... ..' SPRINKLER I sbP�PRESS ON SYSTEM
<br /> Chemical or Water I 'No,of Heads
<br /> ACKNOWLEDGE=MENT: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,ort ern 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 /> City of Everett Official Use Only
<br /> PER
<br /> ...-) ---u.-----
<br /> r'411.31701 it k'T,02 - C)2,‘
<br /> ()Wrier/Authorized Agent Signature Date (Revised 9/23/2016.)
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