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PERMIT APPLICATIOI
<br /> '11.11POSBUILDING/ MECHANICAL I PLUMBING /SIGN I SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
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<br /> 411Ig4 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everettepsfeverettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SIT!INFORMATION
<br /> PROJECT SITE ADDRESS: 1?iat) ‘" .4.4:;‘,\NOu3 DAkS„. (4,,, Li.lkedekt ek961.-14PERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: \\-s\CY‘43‘t k,..--- 1\1:;•5•,,- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET ‘I?) . lAel‘\k,fakiiiS .. :::-Ii2, ç\
<br /> CITY L.--1.1-4,itt STATE *". 41- ZIP s2...9
<br /> OWNER PHONE: 2-06 -*•(1,5\LAQ 4 OWNER EMAIL:
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<br /> CONTRACTOR NAME: , y,,r,),455 ( c '11 /15 1-4—C.,
<br /> CONTRACTOR ADDRESS: STREET ( ? 31 /2' Ili 0 1 t1/421E
<br /> CITY BO'71411 STATE LJ( zip
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<br /> CONTRACTOR PHONE: I--t Li;`1-1,-T c) L...6•ci, CONTRACTOR EMAIL: er-I-CrA , 1. -ir-be,rot-E1.7, Lic, ee t.Ct r,,,,
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<br /> CONTRACTOR LICENSE#(REQUIRED):C-5(198.C:-.-832? ,........‘A CITY OF EVERETT BUSINESS LICENSE#(REQ.,"-ED)
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<br /> PRIMARY CONTACT: 0 OWNER d-CONTRACTOR 0 OTHER(Please Specify)
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<br /> CONTACT NAME: CONTACT PHONE: LA 2,..5'T-4- f GI-P.5i
<br /> Er c-r..,.." D0tr19 ,i-,: CONTACT EMAIL:
<br /> .. . . - - . Bumpt,44:0111,1T APPLIcATIOM
<br /> Existing Use of Building: Contract Price of Work: $ cK,,9, 0
<br /> Proposed Use of Building: (ge4re.,..1-4-,41 i-ikcr i Heat Source: DGas Electric DOther
<br /> Building Type: OSFR-Detached DSFR-Attached DDuplex DIMulti-Family-#of Units: f)/LAe OCommercial Dlndustrial
<br /> Type of Project: El New DAddition gRemodel ORepair On OSign OSprinkier ODemolition OChange of Use
<br /> DESCRIPTION OFWORK: „i k„,i lit -4 ,_ ..4.-41,5 lei 0 ei rik„, 15.404,,,e- v-cl ite-e„
<br /> 41 41w ,Ki 1A'i--otte: ,... C el
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICALPERMIT APPLICATION- :'•;r , '.: ' intolositoiimsiii:****Po!ucAiiini:
<br /> Type of Project: New Addn Alteration Repair Type of Project: _New _Addn Alteration )4....Repair
<br /> #of #of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures
<br /> Fixtures Fixtures List of Fixtures
<br /> Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater I Bathtub Urinal
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting i 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 /> SPRINKLER I SUPPRESSION SYSTEM
<br /> !Chemical or Water I 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 wiling 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 with the State Contractors Law 18.27 RCW and 2962004 WAC.
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<br /> . .., City of Everett Official Use Only
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<br /> Owner/Authorizd eAgent Signature Date (Revised 9 312016)
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