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Om' PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING /SIGN/SPRINKLER/DEMOLITION
<br /> CITY OF RETT PERMIT SERVICES ORIGINAL
<br /> 3200 CEDARARSTREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettaTa.gov/permits
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<br /> PROJECT SITE ADDRESS 1 V�eYa l y. S1�IPROPERTY TAX#: 6 o1 b 1 O b O DO La (000
<br /> LEGAL for new construction: Short Plat//subdivisionUU�CYY``CC V `'►U �V rN/ Lot No. UU (attach copyj� of long legal description)
<br /> . ', . , CONTACT'INFORMATIONt„,
<br /> OWNER NAME: l lit, TENANT NAME (
<br /> Pal (� (�U' � 1 (IfCommercial): ,
<br /> OWNER MAILING ADDRESS: STREET 01 U ,V7,1 Q v' - WI_ V ' v
<br /> (,� CITY V `/� STATE �� ZIP 01 0 oT
<br /> OWNER PHONE: 1 � ,3 '” a OWNER EMAIL: V L 10 J
<br /> CONTRACTOR NAME: gi lA1 0
<br /> -
<br /> CONTRACTOR ADDRESS: STREET 1 (Vj\ 1 '
<br /> CITY M C../ STATE IA)/ 1 ZIP -/�L?
<br /> CONTRACTOR PHONE:''1 c )• I , 1 CONTRACTOR EMAIL: 0 LO` t
<br /> CONTRACTOR LICENSE#(REQUIRED): I� jl &i T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):b �-41 0
<br /> PRIMARY CONTACT: 0 OWNER 9CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAMES: ,, CONTACT PHONE: L, -2,'L�-'',''1 1. 1 k 3 Cl
<br /> V-eA) li,i'VAl�- �� Y t t (/ CONTACT EMAIL: 1 A L�/t
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<br /> �ili�I�i ,' !� rw:i.,. sr? .,., d,i+. ® #� �T-. _ .r E.:" .e�s..a °it4iii9rE"" '�hC�!'��9+1}� l�pali4luNr�„ud'
<br /> 4 tlNll�.Aiyl,'it IN .,pi t, are ,.°L uA e, 1p:;Z 1- _. 'OTt 11l T PPLIIr o + aul 9n:i4i 8ry�.
<br /> ., I (i �a �llw l�..a.�-.. kt r�;b.._ 5 ...:� ,M'�c_�.�.�.��°�tWtaTi.�l,�,-� ..., �.�,��..�..�,....x.�-,,. R�..m..�ve�f rt.�,.�. ���, ..� �+�r �h,I�Lt,�—.,{_l ,ra.�attr.2r�a..:�dN'a11,�,1 i Sw ..,;�k�Y�'��rskl�tlN�
<br /> Existing Use of Building: Contract Price of Work:$ 1 --T w�
<br /> Proposed Use of Building: Heat Source: , as ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached /FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair 01-.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> U (V\ \C Iv. 6 Iia o D
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> . n o. �£:jz e 4' PLUMBING'PERMIT APPLICATION,'
<br /> ;, ,s ,,.MECHANICAI,PERM,IT APPLICATION �a ,_ ��� �3��a .„�,n �, .r,�
<br /> Type of Project: _New _ Addn KAlteration _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 /> rSPRINKLER,I SUPPRESSION,SYSTEM -i
<br /> Number 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.lam the owner,or 1 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 /> l l f City 1of Everett Official Use Only
<br /> /, o _ �f5( 21 t 1 v PERMIT �/1 .1.".6,.... 0
<br /> Owneuthorized Agent Signa a Date (Revised 10/12/2015)
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