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<br /> PERMIT APPLICATION
<br /> ,/ BUILDING / MECHANICAL/ PLUMBING /SIGN/SPRINKLER/DEMOLITION
<br /> vii/OfCITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 j www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION p
<br /> PROJECT SITE ADDRESS: 4 72,7 Vew y> i\, 1 PROPERTY TAX#: 04 4OC, 7 d 17005®a
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 1 L (Pi+Ej pp y 4.,1„e_. TENANT NAME(If Commercial): 460,5e p► et G/F' to
<br /> OWNER MAILING ADDRESS: STREET__ 7®p/_ /J�IF
<br /> CITY `�YL�LI.CJl�.YS4 STATE �/ ZIP b [/ �/ p� �-
<br /> OWNER PHONE: 4 2'5'' 32,7 - L v2 5 OWNER EMAIL: 1 i'v'^1.eoprt .n e014.3-24e,- C !�!M Al!! eO4
<br /> CONTRACTOR NAME: 6, `. et -,/ (A)O®D.II(,ISI` /� 1 VI,C,`
<br /> CONTRACTOR ADDRESS: STREET 02;tib b t g b- wit`' MJ-
<br /> cm V STATE leek, ZIP 111-024
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): 1---14)D orV l' -)i-s4bIblitnryOF EVERETT BUSINESS LICENSE#(REQUIRED505Att
<br /> PRIMARY CONTACT: DOWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> /
<br /> CONTACT NAME: CONTACT PHONE: 4 2 5r 5 2 7 • /L22 5/rld`�( 44.e.. L,, CONTACT EMAIL: T r'zer frk pi'. i- jrh,4jI„,etc
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: gest-Ali "-e I ,stv : Contract Price of Work:$ !l®/-
<br /> �4 5 9 V ® ®D
<br /> Proposed Use of Building: b r4k D.wtiytytc. Ci I ilk. Heat Source: git6as ❑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 PT.I. ❑Signt!❑• Sprinkler ❑Demolition ❑Change of Use
<br /> 17RIPTIONOFWORK: Z7G.r.N.01.1)}1 Ie►r-iii?" 81-1yir � ts„ , ebli,��-r,-1.-/e -' h Walls , J tsh-
<br /> Vlb^il'_g 1 `{lw4\Wi 1 vvvecAott"eo(� e__10.c,�,,,,vc.41 ' v' v t ,--o, r• id dv 1,,i-k,, L� f�,--ttC . (
<br /> -3 0 --i !Rev;.ei ;-14e-..;or` wo- °/A y d kr, Y`�Ill s' ,� >
<br /> eal
<br /> `� 6 /n .t4..) , eels• e . . r� orvi�.,., 4. ha Z�� 44iwn} Spade..
<br /> ASSOCIATED BUILDING PERMIT#(if applicabl ):
<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 I 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 1 comply with the:ate Contractors Law 18.27 RCW and 296.200A WAC.
<br /> I/
<br /> City of Everett Official Use Only
<br /> PERMIT A
<br /> ' S: V (12
<br /> .........._. ...,..,
<br /> Owner/. . horized AgenttSlfgnature Date (Revis f6)
<br /> 23/2016)
<br /> a--i. eJ• 9 LA? .-k le PLL., ..xJ Sl-4` (Q -' 6--\ ,t
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