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PERMIT APPLICATIC
<br /> BUILDING / MECHANICAL/ PLUMBING I 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 I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATI N
<br /> PROJECT SITE ADDRESS:13 ZD iAcl I to,--1 a,u 121.- Ckier 61(S 2.-0'-'t OPERTY TAX#:
<br /> A
<br /> LEGAL for new construction. Short Plat/subdivision Lot No._ (attach copy of long legal description)
<br /> CONTAct',4NIIVRINATION
<br /> OWNER NAME: ‘,..\;(,‘Ailkkk tz'°‘\& v, TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET \3Q(2
<br /> CT y (;:u-ii€t•ett STATE L.-3PC ZIP Ci:S2A Li
<br /> OWNER PHONE: 70'6" -4-(>15 i;--.10"i OWNER EMAIL:
<br /> , ... .,.
<br /> CONTRACTOR NAME: Cxere55 19 ki fii_1:7.41) 64,,,t,
<br /> CONTRACTOR ADDRESS: STREET 11'5,3"1 /Zel l'A ip/ ,V&
<br /> crni :13,14-hetl STATE f")(4.- ZIP el 6 0 If
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<br /> CONTRACTOR PHONE: LAZA -1-4-4 02-01 91.-- CONTRACTOR EMAIL: Z77.y."7-C-k" ,,, 117)<A1r- )CVs-
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<br /> CONTRACTOR LICENSE#(REQUIRED): -Aert :,,-;-4,(......AA, CITY OF EVERETT BUSINESS LICENSE#(REQUIRE*, ' 0 Cil.vV i
<br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: ,--1 76 1--7 4-0 el-0-9
<br /> ,
<br /> CriCiVl ,..1,-,e1 ill CONTACT EMAIL: C 40,,,,, , ry,.,e-4,-; i..1,(2.) Vali-14 '
<br /> BUILDINOMERNIIT APPLICATION ' ,
<br /> Existing Use of Building: R...Ci.f.ok.:-'4',1 I 4:4 I Contract Price of Work:$
<br /> Proposed Use of Building: Heat Source: UGas filElectric 00ther
<br /> Building Type: OSFR-Detached OSER-Attached ODuplex AVIulti-Family-#of Units: aitt 0Commercial Dlndustrial
<br /> Type of Project: ONew OAddition KRemodel ORepair DTA. OSign OSprinkler DDemolition OChange of Use
<br /> DESCRIPTION OF WORK: keriat.e..,Mc ei tesy,;:A 44, -)l7j
<br /> „,,.; V-16'-i /-16., ..t)hoc---e-- v.” A f 4
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: New Addn Alteration Repair Type of Project: New _Addn Alteration Repair
<br /> #of #of fiat #of
<br /> List of Fixtures List of FixturesList of Fixtures 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 1 Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting 1 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 /> . . .
<br /> SPRINKLER./iitipprtiiisioal$YS*EPdr
<br /> .
<br /> Chemical or Water J JNo.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 I comply with the State Contractors Law 18.27 RCW and 298.200A WAC.
<br /> City of Everett Official Use Only
<br /> s,
<br /> ( -'-') IT\.0
<br /> ff Z.3/fPERM
<br /> (S 02- — 002
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<br /> Owner/Authorized39tratignature Date (Revised 9/23/2016)
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