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PERMIT APPLICATION
<br /> -#04,0".1 -7-4.-
<br /> F `r BUILDIN ECHANICAL/ PLUMBING/SIGN I INKLER I 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( www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) . PROJECT SITE INFORMATION .
<br /> PROJECT SITE ADDRESS: IR 2 c n 5t, .v2f2; 6r,\,t/A q �U` PROPERTY TAX#: 0,C266 .21:31‘,� G609 00
<br /> LEGAL for new construction: Short Plat/subdivision q t h.d t'�9-ik of No. (attach copy of long legal description)
<br /> ' CONTACT INFORMATION
<br /> DOWNER NAME: N6�„r.v �24j;,As,,,g,,f, TENANT NAME(If Commercial):
<br /> ;OWNER MAILINGADDRESS: STREET 1c(0 ,5£I'l 5t
<br /> / . CITY 4A,1n4OV'e. STATE V'/Vi ZIP q O�✓),�J
<br /> OWNER PHONE: `, - 1 1 ` (Oaf OWNER EMAIL: ,M.K4 Kw Z Cha ine...,S-1'.t-d '-
<br /> iCONTRACTOR NAME: 5e p(i No op ,V, ?tA,ce±L / :ke S eV 5 /✓ "'✓)it d'F,26_
<br /> CONTRACTOR ADDRESS: STREET 1:13(i' ke -1 , I:•v,L S4e- /0 l /�
<br /> CITY 1/1()(/Ufi/1/t;S` \ STATE �✓A ZIP Elalb
<br /> CONTRACTOR PHONE: L' _ sic).-7`a 647 CONTRACTOR EMAIL:d Iprvl I> �vv/,i,r. ev,,„„.14-v✓a,cvt
<br /> ;CONTRACTOR LICENSE#(REQUIRED):SERV; 4-s.s.7t k,0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):05,)h(5-
<br /> rrte�,, _... .. . _...... .
<br /> iPRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> 'CONTACT NAME: CONTACT PHONE:
<br /> 1 1 t
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<br /> 00,J0, 61 4,lnr�I11 CONTACT EMAIL: dozy-v.,t,10 5e,,,,,Ar,e)t?ue,v,v-I Wet.,ly
<br /> BUILDING PERMIT,APPLICATION
<br /> Existing Use of Building:74/('1-4(,c pm:ty 1-445 ,46e_ ( a.,,Pieu^ i Contract Price of Work:$ A0,00 Oc 0 ; "
<br /> I
<br /> Proposed Use of Building: !jfi,tjy>,e ci 5 cil, J Heat Source: El Gas ,,;Electric El Other
<br /> Building Type: El SFR-Detached ❑SFR-Attached , '6uplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remode! Repair OT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: keple(4. 41;)^2- da(,1w5,�ct .Nk/M,145 t'+,vz,ci 5/cfaU✓5 /dvyvv t1( i /.•5, 14tz:.‘ n0. ceoi'itad /,h.1 i
<br /> 179vi5 •;Pg-141-1 Cu/,tLcf.S f (0:Atei tagi' tr,5 i C"'`�-(-e VO4-tt c F ( G�.--te- , :1n, 4-W-cc-fear(e� An t-r v`('
<br /> cLrpt k dl/t,cy;,
<br /> ASSOCIATED 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 /> 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 /> SPRINKLER/SUPPRESSION SYSTEM
<br /> Chemical or Water No.of Heads 1
<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 /> City of Everett Official Use Only
<br /> ( PERMIT
<br /> ISCI fi 11 (D- 03
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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