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477. PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER/ DEMOLITION
<br /> CITY 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 j www.everettwa.gov/permits
<br /> (Blue or-Black lnk Xily:Please).:-...::: ...:::::... .::PROJECTBITBANFORMATION,::::-:::,::::::.:':i::,::..,,.,,,.'.,-1'1'.•: ;.;•::•••-•••:;:.:',h',.-.-'::::;..:::: ::-.::: .::•-:-.:.::::. :
<br /> PROJECT SITE ADDRESS: It-43)C) ILIC42tA -7.1• ..." As.....- PROPERTY TAX#: ....: ,ç0674 cc s)
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> : .. .. . .::-.: .. .. • .• ,..• : : : • -- •'...:*:: : :.'t,,CONTACT.INFORMATION
<br /> OWNER NAME: -l-viN:,\1/40 9 j AI..49.4...- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET
<br /> Orr! 17:-'j (0) - STATE i.,,,,er ZP Ci Z.6:.
<br /> OWNER PHONE: '1,k 5. .S OWNER EMAIL:
<br /> CONTRACTOR NAME: 4,(. .....!i n-frknrs_k.,
<br /> CONTRACTOR ADDRESS: STREET .;CirTA1
<br /> .. A e.' ?lh.....4<-,
<br /> C fTY -. L12./L./* L.0 STATE ZIP
<br /> CONTRACTOR PHONE: 'CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE it(REQUIRED): A',c",•k4 F--,AL).t 61.'• 4 142..4Z.- CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):C:i.
<br /> .
<br /> PRIMARY CONTACT: I6 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: ‘ CONTACT PHONE: 'LOU-cic----c-1: 1
<br /> VI)( J .14-,C4-Z CONTACT EMAIL: \.7
<br /> Existing Use of Building: Contract Price of Work:$ _CO
<br /> r...-^,.
<br /> Proposed Use of Buildjag , Heat Source: &GO.) 0Electric 00ther
<br /> Building Type: Et(FR-Detaehetr) OSFR-Attached 0 Duplex EJ M u hi-Fa m i I y-#of Units: 0Commercial Olndustrial
<br /> Type of Project: ONew DAddition El Remodel CI Repair El T.I. 0Sign CI Sprinkler 0Demolition OChange of Use
<br /> DESCRIPTION OF WORK:
<br /> t'f4....rke-k-QL CP YVA.CO........
<br /> ' V il
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> : . :.1i...MECHANICALPERMIT;APPLICATION:,...:::.:::. r . ::..:.::,..:: ';..:.:PLUMBING,PERMIT APPLICATION,..,. ..,:..:.,. .„.,, ::,::'...'
<br /> Type of Project: , New Addn Alteration Repair Type of Project: _New Addn Alteration _Repair
<br /> #of of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> —
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> —
<br /> .i 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 /> : . •SPRINKLERI:SUPPRESSIONSYSTEM::- :-:-.
<br /> Chemical or Water 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!am authorized by the owner of this property to perform the work for which application Is made,
<br /> and I comply wjt the State Contractors Law 18.27 RCW end 298.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMIT4
<br /> Owner/Authorized Agent Signature ""Ddte (Revised 9/23/2016)
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