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PERMIT APPLICATION
<br /> BUILDING/ MECHANICAL I PLUMBING/SIGN I SPRINKLER! DEMOLITION
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<br /> 44&FY 32CITY OF EVERETT PERMIT SERVICES
<br /> 00 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 l IE)everetteps@everettwa.cov I www.everettwa.gov:pa I ir:iS
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<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: le'';`,.'-',' (.)f-'' ri:,_ ,;--2 A t PROPERTY TAX#:
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<br /> LEGAL for new construction: Short Plat/subdiv4s,on __Lot No. (attach copy of long legal description)
<br /> - CONTACT INFORMATION
<br /> OWNER NAME: 1 4,47,,i .f:-"ffi i I..) TENANT NAME(It Commercial):
<br /> OWNER MAILING ADDRESS: STREET 670<:6
<br /> kie2E'17 STATE
<br /> OWNER PHONE:-4-1,7 C7) • —7,--2n ' OF.`t--3'-'1 OWNER EMAIL:
<br /> CONTRACTOR NAME, 1 - i f::,,)C g L.--i 0 f\...1
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<br /> CONTRACTOR ADDRESS: STREET I/C.r)I Wilt 1-7 /OE
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<br /> CITY , i k I,0q1,-)1) STATE ' i rf'- zip
<br /> CONTRACTOR PHONE: 't:;:-.) c4C.,,k_ L.,1/4.(1,”,:. CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE tREOuiRED): -1/4,)L.c\cy. L rr,-,- -{''', C' C CITY OF EVERETT BUSINESS LICENSE#fREQUIRED):t:..f ‘
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<br /> PRIMARY CONTACT: 0 OWNER V.:CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME; 1:.-...),it(LOU. (-21:-...... --cc)\-)k'„\.,1 CONTACT PHONE:.4.1•2_,
<br /> CONTACTEMAIL: cv-A,2,; i
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<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$
<br /> Proposed Use ol Building: Heat Source-. OGas DElectric 00ther ...
<br /> Building Type, 111SFR-Detached OSFR-Attached °Duplex Olvlulti-Family-#of Units: ClCommercial landustrial
<br /> Type of Project: Jew 0Addition OFkernoctel °Repair 0T1. °Sign OSprinkier °Demolition 0Change of Use
<br /> DESCRIPTION OF WORK; \I----ASSOCIATED BUILDING BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project. New Adcli) AIteratien Repaii Type of Project: New Addn Alteration _Repair
<br /> #of
<br /> List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Mei
<br /> Forced Air Systems Unit Heater Bathtub Urinal
<br /> Gas Piping 1 Boiler Lavatory(Wash Basin) Drinking Fountain
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<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 Drier. Clothes Washer Medical Gas
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<br /> Range Hood Water Heater Other-
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<br /> , Exhaust Fan Sink(Service/BariMopietc.) Other.
<br /> SPRINKLER! SUPPRESSION SYSTEM
<br /> --'- Chemical or Water 1No.of Heads
<br /> • ACKNOWLEDGEMENT:i have reviewed this application and confirm the information contained herein is true and correct.Work dorie pursuant to this permit MUSS corm!),with
<br /> current federal,state,and local law. The granting of a pealtit only authorizes approved work and no deviations therefrom Deviations must firs-t be authorized In writing from file
<br /> Building Official before being authonzed under any circumstance,I am the owner,or i am authorized oy The own&of this property w oerform the work for which application is made.
<br /> and t comply with the Slate Contractors Law 1E27 RCW and 296.200A WAG.
<br /> City of Everett Official Use Only
<br /> • ,, i PERMIT#
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<br /> -----) V-7.,/ ri ro\-1,02-- () 10
<br /> Owner/Authoi,ze Agent Signature
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<br /> Da (Revised W23/2 15)
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