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PERMIT APPLICATIOt L
<br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION
<br /> tI�^� CITY OF EVERETT PERMIT SERVICES
<br /> � N"IIIIP
<br /> -r513200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJ ECT_SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 1 30 3 C C,GI 3 ;7,.0 /(�Vai PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: inZ ch F,0,it -d,.Q„,J-et,j - '0,4.0,.. TENANT NAME(If Commercial): _5�-/yam a, QUry2.,,—
<br /> OWNER MAILING ADDRESS: STREET /3 ®3 V.. (--Fit) ...70 k0,d
<br /> CITY l..+-.i/..er,l'1` STATE liv 09 ZIP q ;L 0_
<br /> OWNER PHONE: 51 5-937 ;J b 3 OWNER EMAIL:
<br /> CONTRACTOR NAME: 6 IA y..4_. Coy,.3 tr e"<.),.,,1_1 C�
<br /> CONTRACTOR ADDRESS: STREET 1 /l7/' /' /JL. ; ,...0.73-7 5t4.: L.e *5---/2/
<br /> CITY 1 .. / ,//- STATE ‘/I,,,,/42 //4J ZIP `tel 4"24:01"S7
<br /> CONTRACTOR PHONEA1:„3 „,7 g)74,2 rr CONTRACTOR EMAIL:444 e is.T1,-0 y)+rt L..,,,et y , ,A.
<br /> y, , G0
<br /> CONTRACTOR LICENSE#(REQUIRED): j(II /ma_ ?6/,'/i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):,j y 770
<br /> PRIMARY CONTACT: 0 OWNER IVCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTNAME: CONTACT PHONE: -23a e)�(�.
<br /> f I>41 \ l CONTACT EMAIL: 5a rae ,.." ho,----,-.
<br /> BUILDING PERMIT APPLICATION
<br /> b°Existing Use of Building: Contract Price of Work:$ \io boo,
<br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> 0eJ I ,..5-1-1(L, ciA Jo t.,... 1 A f ri
<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 /> NC-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 I No.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 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 /> r�7 jF PERMIT#(� 1 (6 kip 6 O/1
<br /> 1.
<br /> Owner/Authorized Agent ignature Date (Revised 9/23/2016)
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