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eltP/s0//—_ PERMIT APPLICATION.
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER I DEMOLITION
<br /> 44..." , CITY OF EVERETT PERMIT SERVICES
<br /> ,44w
<br /> ...7, -7
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwagov I www.everettwa.govipermits
<br /> (13.102fa or Black Ink Only Please) titioNFottmATIoN
<br /> PROJECT SITE ADDRESS: 16 lc.5 g gv.,,,44- tyt,./t Way
<br /> PROPERTY TAX#:
<br /> LEGAL for new construction: •Short Plat/subdivision / Lot No, (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME:Sesy,rteke Cov-p. 1.:teriev-nov4:dpup I TENANT NAME(If Coinmercial):yies5 jcti,..,0 Isoterivek4( ti:tfk
<br /> OWNER MAILING ADDRESS: sineer 136C V, totteviebe ,SL.
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<br /> crry 5(itt ItrA rug, arm wet, zo r 2,5i
<br /> OWNER PHONE: cylr-32 47-6‘41 --10YYNER EMAIL:
<br /> _.,
<br /> CONTRACTOR NAME: Ceig: ,ick
<br /> CONTRACTOR ADDRESS: s-reeer3q IC 13... s4., k i , ,. *
<br /> CIlY A iltbrAret STATE V./tot, ZIP d&O0 I
<br /> CONTRACTOR PHONE:Z.,53-z W-33 ,s...r CONTRACTOR EMAIL:376.4;4.1i,„.„4„,21ec,,,,,,k„,,,,,„„ik.,„,,,,,
<br /> CONTRACTOR LICENSE ft(REDUIRED):CA(yr.ite*ecict iv? I cm.,OF EVERETT BUSINESS LICENSE NREQUIRED):Ortiq COI/
<br /> PRIMARY CONTACT: 0 OWNER jaCONTRACTOR 0 OTHER(Please Specify) ,
<br /> CONTACT NAME: CONTACT PHONE: 2_,,s-- .....a
<br /> c‘tAirlim Wotent'eVol CONTACT EMAIL:3;fkr1.7t-ipi fiarbtAti...tarri:matit,Cool
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<br /> Existing Use of Building: Contract Price of Work:$ ' 4 di
<br /> Proposed Use of Building: Heat Source: OGas 0Electric 0Other
<br /> Building Type: DSFR-Detached OSFR-Attached ElDuolex 1:11ViVitl-F.mil -#of Units: t,- ornrnerclal Olndustrial
<br /> T pe of Project: :New DAddition r3 Remodel OR::.-ir Ott. OSis,n OSprinkier ODemolition OChari.e of Use
<br /> DEICRIPTIP„N OF WORK:,$1nAte- (qtree" "Gv–e 1 CIA. te...Oslo reotteve exl sit 5/4f3 -#t Zrt • I if,4,;444 040,45 0 eek NI,/
<br /> AeMter.' 7- 1'91-IslAno. 44/104 sp*t,S. 5;.nikie, lo, sr- (0 t".:4"1-149 Pull,. A. itteerd e'er- Manarat 4-4 0 e SeecS. 1
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<br /> Al yeae. 141)0v-atid Plevfvi vv0417644,".
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> %-,MECHANICAL PERMIT APPLICATION'', ' , . '< ' PLUMBING PERMIT APPLKAtION'i'
<br /> Type of Project: New Addn Alteration Repair Type of Project: New Addn _Alteration Repair
<br /> fl of *of *of *of
<br /> Fixtures
<br /> List of Fixtures List of Fixtures Fi . List of Fixtures List of Fixtures
<br /> Fixturesxttires Fixtures
<br /> ,
<br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) ,
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping Boller 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 /> ` 1
<br /> 'Chemical or Water I [No.of Heads
<br /> ACKNOWLEDGEMEIVT: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.rhe granting of a permit only authorizes approved work and no deviations therefrom.Deviationss must first be authorized in writing from the
<br /> Building Official before being authorized under any circumstance.lam the owner,or!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
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<br /> / , 40y 4,, PERMIT# 6 n 12,, OH 1 ,
<br /> •-a.D.c..1",
<br /> a wner/Authorized • ,ent Signature Date (Revised 9/23/2016) /n!
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