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PERMIT APPLICATION
<br /> ey*if/--,,IPLABUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLITION
<br /> t CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> S
<br /> (P)425-257-8810 l FAX 425-257-8857 i(E)everetteps@everettwa.gov l www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE� INFORMATION
<br /> PROJECT SITE ADDRESS: /772 w, k4 Eaei,,p \f rt(3,,,) Pe. PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: TENANT NAME(If Commercial):/J -Aevt `S M)OacJ,',tee.. 6v-i'It
<br /> OWNER MAILING ADDRESS: STREET '
<br /> CITY STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: I �)r,,,, /s )44 Pc ,p kureet C PI-4-(j
<br /> $
<br /> CONTRACTOR ADDRESS: STREET 660,2 1,,,_,/1,,H.,co,& ,er7 A ..2
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<br /> CITY ifi(S 4",6to.,/ GG ✓�{
<br /> / - IA.,TE 9 p 33 5 ZIP
<br /> CONTRACTOR PHONE: 253-22 y-i/45 CONTRACTOR EMAIL:-1-;r,,,,c eL ef<1r Ca_1. .1-€vaso,COVvt
<br /> CONTRACTOR LICENSE#(REQUIRED): T(vis 04 yvire,e7 Cs CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER j&CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: , CONTACT PHONE: 2_5 3_z L_30 6,5
<br /> -7-1 t..-, e.,,oK CONTACT EMAIL:
<br /> IL/IA.4.s tµec ka K r caC_ .� &___tv,ts2, r©v�
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: )?es-a.vi ra„`-1- Contract Price of Work:$ 2,500
<br /> Proposed Use of Building: Heat Source: ❑Gas (Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial 0 Industrial
<br /> Type of Project: El New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> T mss-14,,11 re-r� era-41?0," —c 64i• -1'or Firos'7t /2q, L
<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 List of Fixtures #of List of Fixtures #of List of Fixtures #of 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 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 /> SPRINKLER/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 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 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> r' 0 PER IT#
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<br /> Own: uthorized Agent Signature Date (Revis 9 3/2016)
<br /> (11
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