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PERMIT APPLICATION
<br /> 04[77 BUILDING/MECHANICAL/ PLUMBING/SIGN/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 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> PROJECT SITE:INFORMATI,ON . .
<br /> PROJECT IT AI . S:c a i4 0 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> t;. .: k.. `.::;CONTACT INFORMATION {_
<br /> OWNER NAME: NI t ica $�-1�-iF( J v'P.j Ak tr SME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET 7 1 k iplitActs,e, r4,
<br /> cn . Cath Q W l STATE 11/41.3 IL ZIP (1.Z164
<br /> OWNER PHONE: ‘2.,610!r— 4( OWNER EMAIL: (;i.htti'E io t Lt I 3 ' , P_t 1
<br /> (( r�
<br /> CONTRACTOR NAME: kO(x� �T1 1_4.' ,Q_ )
<br /> CONTRACTOR ADDRESS: STREET GQcQS kL-L
<br /> CITY lil ,....---- STATE lijZIP 41000
<br /> CONTRACTOR PHONE: 2.cCo ( ,g( 202,1- CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED):I ) SL$S 211. CITY OF EVERETT BUSINESS LICENSE#(REQUI ): 5 •ct
<br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR et (Please Specify) ;,-%, tcQ j i C-a-t&.,si¢
<br /> CONTACT NAME: e'CL a d 0--e- 0 CONTACT PHONE: 1-4 25 -$ lO —.0 5 I
<br /> CONTACT EMAIL: a caisAot a @ 7') a /"JDik.6LI- .1--avi ,,covvt
<br /> BU,ILDINGtiPERMIT,APPLICATION.
<br /> Existing Use of Building: VI,I -, r , t) /f L.c Contract Price of Work:$' ( 0®) GM
<br /> Proposed Use of Building: $ .. Heat Source: ['Gas I$Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ®Multi-Family-#of Units: ['Commercial El Industrial
<br /> Type of Project El New DAddition ❑Remodel ImRepairt ❑T.I. ❑Sign El Sprinkler El Demolition ❑ hange of Use
<br /> DESCRIPTION OF WORK:e�Q149,..J G 1,0 / , 9�l,f li, j 1it.5
<br /> u� U�� �`Q/t �,�6�.t�l�iW V`,c�-v � © v .�JVV
<br /> 8 o i A? �j k sO fiJ 4 /466) 4,5041/ AK6
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): 101
<br /> ,; MECHANICAL PERMIT,A.PPLICATION.;`,., ePLUMBING;PERMIT APP,.LICATIONS„;;,, ,.,,l,,,,,
<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 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 /> ,r §:1* KLER`%SUPPRESSION SYSTI~M<<
<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,or lam authorized by the owner of this property to perform the work for which application Is made,
<br /> and I comply with the Statentractors L w 18.27 RCW and 296.200A WAC.
<br /> (-- City of Everett� Official Use Only,
<br /> j (Coo
<br /> �� PERMIT#/ no V -D2-
<br /> j
<br /> Owne/ thorized Agent Signature /I�/Date (Revised 10/12/2015)1
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