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PERMIT APPL.ICATiON
<br /> BUILDING 1 MECHANICAL I PLUMBING/SIGN I SPRINKLER I DEMOLITION -
<br /> r -04,,-,.4.' . ._ _ CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> 4_Iliad
<br /> (P)425-257-8810 I FAX 425-257-8857 T(E)everetteps@everettwa.gov I www.everettwa.gov/permits .
<br /> (Blue.o r black Inds Onlll•elease) .PR',i JECT SITE INP®.=:[VIA`rioN • • '
<br /> PROJECT SiTE ADDRESS: l 32.1 'jE , CUietrtT NA-II PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
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<br /> ri n y�1• .cot,iiAGT.lkiP®RMATT'I®N . '. . . ' -
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<br /> OWNER NAME: c P O ti O N•-s TENANT NAME(If Commercial): ,
<br /> OWNER MAILING ADDRESS: STREET I,t9k 0)C •-z*3dbS - •
<br /> `` CITY DA a g � STATE " ZIP '75 3 `
<br /> OWNER PHONE: .._,._. 1 . ,.,,.. . -- ..,....,..._ ..._.,... ....,__,...._, DOWNER rittAtk 214 -3 40 0833
<br /> ,.,,,... .,.,.Y._ „...........-,
<br /> CONTRACTOR NAME: E U CP.60, ,AJ 57Tr �(.4 1/4,617A-C.1/4,617A-C...6
<br /> CONTRACTOR ADDRESS: STREET "2-1.2.-oeArcA ytC AU e" Q�p�
<br /> I-rt 'F;a 1,/ STATE (� _�- ZIP /�S20(
<br /> CONTRACTOR PHONE: 4`2.5--2c 2."" /114 • 'CONTRACTOR EMAIL: /IAA
<br /> t2 k 'S.55/1ju/A £G
<br /> CONTRACTOR LICENSE#(REQUIRED): EVel(.(.5,S c2.Zo`f' 'CIN OF EVERETT BUSINESS LICENSE#(REQUIRED): is 6-1 gif 55-
<br /> PRIMARY CONTACT: ❑OWNER RCONTRACTOR 0 OTHER(Please Specify) •
<br /> CONTACT NAME CONTACT PHONE: 4 7 5-7-5-2-,119
<br /> CONTACT EMAiL: A,,,;
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<br /> �iJlt HIIN�PERMIT APP LICA`l ll�M ,t.�
<br /> Existing Use of Building: /V f!�61� 1 Contract Price of Work:$ �4/t 000
<br /> Proposed Use of Building: AI0 & Vde IHeaf Source: ❑Gas I, €lecfric 1]Other
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<br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex ❑Multi Family#of Units: commercial l�Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel EARepair ❑T1. ❑Sign DSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: 3 4f4 j6 4 R LS.. �j r to c .L /avic,`e,,,,,4.,:.442.6 I 4,,e ®„/e
<br /> off' OC-0 VN c1"5, 5NoPu0 AATE' `
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
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<br /> :M4EC6 .ANICAL.PEM/IIT APPLICATION . . ' . PLUMBING PERIVIUTi PIPPLICATION
<br /> Type of Project: New Addn _Alteration _Repair Type of Project: _New Addn Alteration __-Repair
<br /> #of List of Fixtures °f List of Fixtures #of List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units (P 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 HeaterRefrigeration 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 /> .SPRI6VIKILl5R/,OUPPRkSSION SYSThM I '
<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.lam the owner,ori 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 98.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only(
<br /> e,--\Qo,__, ___ 3iI5( ` U PERMI t'3 DE - o `9
<br /> Owner/Autho Agent Signature Date (Revised 5/20/2016)
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