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PERMIT APPLICATIO
<br /> BUILDIR�ECHANICAL/ PLUMBING /SIGN ' _INKLER 1 DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVIC
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: 22 C) 0 g y)Pt C__- Rio A. `5-0-e e- 4- PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: ,Ty 49 t1 4-11 TENANT NAME(If Commercial): 0,
<br /> j,,3-p,,, .yl V.,. Q
<br /> OWNER MAILING ADDRESS: see 2_2_0 0Ijr-y- 1,',I ( .s(,��
<br /> offs( ,/.. -,6.4.� STATE (A) - ZIP .9/ g 2_03
<br /> OWNER PHONE: 47_5_ 2_6 C, - 80 (.7))._ OWNER EMAIL: Gia`i a.4 h i •�cr r ns,V a& (e6R c3•roc i)to
<br /> CONTRACTOR NAME: -3 0 D 4 o 4, ti 4-‘...An.
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY STATE ZIP
<br /> CONTRACTOR PHONE: CONTRACTOR EMAIL:
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): iA 'P,,,-4.,\
<br /> PIMARY CONTACT: D OWNER 0 CONTRACTOR 0 OTHER(Please Specify) '
<br /> CONTACT NAME: CONTACT PHONE: LI zS .- °--r'- r eT,Lk, ca,
<br /> ap - .` w" CONTACT EMAIL:6-J�" Cit•-t11 nt• r r Ve'e..,SCI("1 rr gp a/• et;'t!,'nw
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: C,r,,, .c ,,,,,\ (mac, tti.eleN Contract Price of Work' :.ter) .• Air _ •!l.'
<br /> Proposed Use of Building: Cc:�m c,,c.A..-t L '�-c,t,,..�.iA Heat Source: Deas -El ,,:,.a,.a ‘111■[�t'T�'�
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: EICOITlrllercial 0 Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair &kr ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ? Ori. AO - 5AC,..4- 14& r j0 00 (plc„ ,,,,Iasi\ t=cc..
<br /> °�' LO'�h e. (f FbO`/F°°`/-SL L c- -----Ake-e. CO" l
<br /> ASSOCIATEl3'BUILDING PERMIT#(if applicable): Tod-.a�'�'
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New Addn _Alteration _Repair Type of Project: _New idn _Alteration Repair
<br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump 0 Toilet 0 Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater 0 Bathtub e Urinal
<br /> Gas Piping Boiler 0 Lavatory(Wash Basin) rD Drinking Fountain
<br /> Water Heater Refrigeration 0 Shower (� Floor Drain __
<br /> Gas Fireplace Wood Stove -:3 Kitchen Sink&Disposal,/ 0 Grease Trap
<br /> Gas Range Ducting '1 Dishviasher•. Roof Drains
<br /> Clothes Dryer Hookups Other: n Clothes Washer Medical Gas
<br /> Range Hood 4) Water Heater () Other:
<br /> Exhaust Fan r) Sink(Service/Bar/Mop/etc.)/ 0 Other:
<br /> SPRINKLER/SUPPRESSION SYSTEM.
<br /> Chemical or Water I No.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.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 FvprAft official Use Only
<br /> PERMIT
<br /> Al" (6 .03—* 65
<br /> ........................
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016)
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