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PERMIT APPLICATION
<br /> eP:-... BUILDING i MECHANICAL / PLUMBING I SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERE(1 PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everetlwa.gov I vaww.everettwa,gov/permits
<br /> ,... ..: _L.PROJECTSiTE 1idFORiMMATIOId
<br /> PR T 1 AD,f? :5 kb, 64 eeit
<br /> PROPERTY TAX#:
<br /> LEGAL for new co✓nstruction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> .r_ .;. ...,,..; ;..__:_ _ : ES, .,CONTACT INFORMATION
<br /> OWNER NAME: 1. I Hell f Ole el,'6e" .131,c//r"1n r 'TENANT NAME(If Commercial): 1ftoliA,/I!I ,t 1!(.q ? Ike
<br /> OWNER MAILING ADDRESS: STREET *05 �/ i--> jff.,-Fe, 4-
<br /> cr, �Ve/rr' t� STATE tA.,i ZIP __(.1(- 2,Z'„5
<br /> OWNER PHONE: 4 - 33:. _C0I a1 ..... ......... OWNER EMAIL:....` C,Via 4-�C.2) Ui 6'Ar'6`l V is u.0 e Lev\
<br /> j � p
<br /> CONTRACTOR NAME: p i.l 'r=_,:t- "��'�tU'Y(.. ci ill 17�1ert.,l4t,1t /IAA"?�r(a✓l,t,t"' 2'S #.+�lv'3 lltt.'. .', .J4L'S , /AIL,
<br /> CONTRACTOR ADDRESS: STREET )51 2,2.) frly�j"E�'�Z*,.),4-/',1.de �r?Jac.a... S4-A2210
<br /> CITY .cpl e I GV 14 1' L W I (M z'/c STATE t.v A ZIP
<br /> CONTRACTOR PHONE: 46.- .A- -. Z-j?ji.'/ ry y CONTRACTOR EMAiL: j(,re e:= 6.
<br /> 4 , - ('ty')/jee'?‘1=, ile- '
<br /> CONTRACTOR LICENSE#(REQUIRED): L, O) 1 . // CIN OF EVERETT BUSINESS LICENSE#(REQU)RED): 5:q7
<br /> PRIMARY CONTACT: 0 OWNER Kf CONTRACTOR 0 OTHER(Please Specify) I / r,°: ,.L- /' J i6i)vt it>,ia�' C?L
<br /> CONTACT NAME:, .- CONTACT PHONE: 42.,6" - RI? 2_,? %-y
<br /> 1'I "'' CONTACT EMAIL:
<br /> '0'21 �L-'. GJ C%[!'fj'yieG7ol-, /iP
<br /> itte ;. ag .. ,., ,v; i .._. ,. ,, tpu,!DING PERMIT,APPLI.C:ATiON f. 1 `
<br /> Existing Use of Building: vrk�G/iee'LI/cf?i e el-704-45rContract Price of Work:$ -„;ice%`..a - -- '_ ,.r
<br /> Proposed Use of Building: Aie%df c�L%/�-4 ,i. ' p(4'c,.y Heat Source: CKGas 0 Electric DOther
<br /> Building Type: DSFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: I Commercial @Industrial
<br /> Type of Project: ONew @Addition XRemodel DRepair DT.I, ❑Sign ❑Sprinkler 0 Demolition Change of Use
<br /> DES RIPTION OF OR �,
<br /> ,tc/'`I"i"t'�'+1 (11491 G f C`F4;CC ,bi/'i 1L, ,-,i4t J6iav"'o dic-taco` .. .) G.wk /...6, sof' , `-c;-ts, e
<br /> I /re0ill, . a-. 5{c.4 heed 1c-ei'i cpei Spade,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> n:MECHANi;G 1#061ITAPPLICATION_ .. PLUMBING PERMIT Ao 00 OttOORONEEBARE
<br /> Type of Project: _New_ Addn _Alteration Repair Type of Project: _New Addn JAlteratio. ' Repair
<br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixture
<br /> • A/C-Air Handling Units Heat P. p Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems 1.1.• Heater Bathtub Urinal
<br /> Gas Piping :oiler • _ Lavatory(Wash Basi Drinking Fountain
<br /> Water Heater Refrigeration _ Shower Floor Drain
<br /> Gas Fireplace Wood Stove _ Kitchen Sink P. Disposal Grease Trap
<br /> Gas Range Ducting Dishwas -r Roof Drains
<br /> Clothes Dryer Hoo ..s Other: Clot . Washer Medical Gas
<br /> Range Hood - - .er.Heater �—Other:
<br /> Exhaust Fan oink(Service/Bar/Mop/etc.) Other:
<br /> rrt . ,SPRI, , _LER.I SUPPRESSION SYSTEM.. .' ” _
<br /> • Number of Heads .
<br /> ACKNOWLEDGEMENT 1 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 i am authorized by the owner of this property to perform the work for which application is made,
<br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> ni:...4_66..„../. _....0,"..z....„...., 3- . .-/ e .- --a0-3—r-:—.qa._...._
<br /> •wnerlAuthorized Agent Signature Date (Revised 10/1212015/
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