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PERMIT APPLICATION
<br /> BUILDING i MECHANICAL/PLUMBING/SiGN/SPRINKLER/DEMOLITION
<br /> ,IP/SZ—_
<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 I www.everettwa.gov/permits
<br /> JECTSITE INF`ORNIATION.,;�„T„
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<br /> PROJECT SITE ADDRESS: PROPERTY TAX#:
<br /> ("O7 e\fe Ce NA- mc&Ii Wal RP
<br /> LEGAL foF r5ew construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> r y. S L 5h ;GONTAGT IN ORNIATiON ,,w ..x t i ri n;
<br /> OWNER NAME: TENANT NAME(If Commercial): /2 c aAS 1 Qt/
<br /> OWNER MAILING ADDRESS: STREET I
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: @p,Fr Svsn Ser\Ittes
<br /> CONTRACTOR ADDRESS: STREET 1 Oa'a., p O ,\l- E.ICX.�y-- ti,,�,y �Fap 3 9
<br /> CITY Milt Cite). �/_ STATE Y Ar ZIP q f30)k
<br /> CONTRACTOR PHONE: 25 330. Si bC) LoNTRACTOR EMAiL: bbt�s►9nSP ins h, Corr
<br /> CONTRACTOR LICENSE#(REQUIRED):3 (I `"Ig" -1 0 O CITY OF EVERETT BUSINIESS LICENSE#(REQUIRED):p 5 5 10 q
<br /> PRIMARY CONTACT: 0 OWNER ) ,,ONTRACTOR 0 OTHER(Please Specify)
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<br /> CONTACT NAME: 4 i se,i('
<br /> ' CONTACT PHONE: 125, 33a g/ Q
<br /> CONTACT EMAIL: jab-I-5 T rnsr), Corr
<br /> _ri,o„ _ ;},z x :sem °.Z- '.
<br /> . .:r.P.�.�..._.:_��`sv t:.�. �_�,,�.� _.� : ;:.� ......_.:.��,BU.,ILDiNG�PERMiT APPLICATIOIN�":�',_. �. .. ... �`�::, �...._... .._ �.��_,.. - �.. _�,:�:�
<br /> Existing Use of Building: 0,_O yflyj 9 ' .Q,/ Contract Price of Work:$ I,ID 5 0
<br /> Proposed Use of Building: t I A Heat Source: ❑Gas DElectric El Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ©New DAddition ❑Remodel DRepair 071 wign ❑Sprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> tn**u"" 0) LED C,'hann& 1,ee( S‘5n d.vsc\ct .
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> nalfhttliWitita#OW0140#111taidgina v_,_ :g, ; iPLUMBING';PERMI ;0000 1tAli '' r ,_, 4
<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 #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures 6
<br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) i
<br /> Forced Air Systems Unit Heater Bathtub Urinal t
<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 /> OWNKL ER/ti.:000:00: i I S
<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/am authorized by the owner of this properly 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 /> 4 4111 /
<br /> � _ / C �� i � PERMIT# \ 1bo2),(ri3O -Lf v j
<br /> ed Age Si. atur> Date (Revised 10/12/2015) (7j,.. ,,,,,," "---*1
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