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PERMIT APPLICATRI I
<br /> BUILDING / MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> CITY'OF EVERETT PERMIT SERVICES '
<br /> 3200 CEDAR STREET, EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Bli a oI 1 = 1clnic#OMY Rta,i, ,`"== glPRO*ci S[TE=INFORM lT(O 1 11 t ta "a!ea
<br /> PROJECT SITE ADDRESS: 3301 f&cuGlc4 R 14ve' PROPERTY TAX#: 0043647 B O cq
<br /> LEGAL for new construction: Short Plat/subdivisioneV.put. A purr•Mc"alum No.(flfj,(attach copy of long legal description)
<br /> ys m ,CONrACTI.NFORMATION, " „
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<br /> OWNER NAME: H'T 12,041ccs A /r"KeJ t+io r.r c TENANT NAME(If Commercial):v'tit0 Tort * C unto j'
<br /> OWNER MAILING ADDRESS: STREET � 3 4o S j J t&t/t; NE .
<br /> CITY {C I rt lc t.. 41.49 j !.✓A q $ 0 3 4., STATE ZIP
<br /> OWNER PHONE: OWNER EMAIL:
<br /> CONTRACTOR NAME: VIA 1,$(-6,s.e.ct- "Ni-ci tAL)
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): 1 tb f., f �}C 1 _ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) q)11� L
<br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR OTHER(Please Specify)
<br /> CONTACT NAME: DO IL A{Z,c H t'[.a-Gr we C. CONTACT PHONE: 6 4.zr) Z,5-2. • 2 F53
<br /> ". Re S S ti A sto.F rvt4 CONTACT EMAIL: h..-4 do 29 1-2 at.re.& g c%,s^a . c ds.-1
<br /> k '¢fes RMIT APPL`IGATION}
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<br /> Existing Use of Building: C. N K $-c.4.rte - C t M'r'ErL Contract Price of Wo :$ uffr•d
<br /> Proposed Use of Building: C artiMorl-e_/,Nt Heat Source: ❑Ga. 0 Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: Worn •- lal ❑Industrial
<br /> Type of Project: ❑New ❑Addition 0 Remodel 0 Repair ❑T.I. ❑Sign ❑Sprinkler 0 Demo I Ion ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> a 12:444a 4..m P o 2T i+ 0 r e x t rr rA-4 C/wt c,. c.,41-L o la-
<br /> rva./
<br /> NAL✓ // I 01-4 IL•.l_c.. •v1, p p 0 cr•-•1'4 r rias s-t P-
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ,*4:1 AN00-PE,R*f,;APP>`ICATIO.N V M . ,. „,PLUMBBING PERMIT APP ICA'TION .N, s R
<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 /> 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 /> :710RiNKIJ RftiSt0 RESSI"ON SYSTEMA"`, i
<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 /> PERMIT\�02 -003
<br /> Ow r/Authori.-d Agent Signa re Date 1 (Revised 9/23/2016)
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