|
PERMIT APPLICATION
<br /> BUILDING 1 MECHANICAL I PLUMBING I SiGN I SPRINKLER I DEMOLITION
<br /> 4,
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 ( FAX 425-257-8857 j(E}everetteps@everettwa.gov J www.everettwa.gov/permits
<br /> til i, r=:....,;?. ...,., = a ra ,w P_ROJECTAlT 1NFORMATIAN...:.,-_ OM -O __n SP. nN
<br /> PROJECT SITE ADDRESS: PROPERTY TAX#:
<br /> c/o oly,,,..0tG Dr f oc>3'M ooca�;oO
<br /> LEGAL for new construction: Short Plat/subd€vision Lot No. (attach copy of long legal description)
<br /> I
<br /> _-,..v:e xA sM' _: WS2-R-:.R.SntR4t. GO#t1 AG; fCtOT§VTpT ON``G EM ._.R .rR' ..EP =t_ . <_....-. gata--
<br /> OWNER NAME: A ccG Skr,w T' — ,r,e,r TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: smear -7 510 6\�.�,. r-- CSC S:=
<br /> cn'v 1-:""LS.2_.,(..2.. - STATE ZIP `'(•n 7.3�'
<br /> OWNER PHONE: S Zp Zcip , y 5 7,-3 OWNER EMAIL:
<br /> CONTRACTOR NAME: \<G\y .e 1L-)—c9 e,
<br /> CONTRACTOR ADDRESS: STREET Ci c7 Z S \ '—. -&d c, I a k,p 0 (' .ie. 6 1{�
<br /> crr Cj�'1Oho�n�.:x� STATE tiO e=) ZIP 2-ego
<br /> CONTRACTOR PHONE: `3Go- 5 CoZ CONTRACTOR EMAIL: t✓:-,, +Gc, ® ore-.r„ c.,;,
<br /> CONTRACTOR LICENSE#(REQUIRED) �!�AL.v,-� H a 4,C, -._ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):O-3 y Q L\
<br /> PRIMARY CONTACT: i OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: S (-t 5 83
<br /> A re se CONTACT EMAIL:
<br /> I sl a. .� �t�. ,� ', _; '-' ;*)fi SING Pl _RkftAPPt CA :IDAY x.._ a ,tiffs.� ,�:te
<br /> b... .t:.t.re.+h!iF'.�.••iL�,S,Yt... .GA'h ........ +�,_�..�at...�..< ..,�._-._ .,. .Y_...£:_u�-. --.. ..-..F. .-.:,trt. ...J}_-......x'."i+:__ `.e'F�' }f(?
<br /> Existing Use of Building: Contract Price of Work:$ C.3 o S
<br /> Proposed Use of Building: Heat Source: fKIGas @Electric DOther
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ©Duplex @Multi-Family-#of Units: @Commercial @industrial
<br /> Type of Project @New @Addition @Remodel @Repair DT.I. @Sign @Sprinkler 0Demolition @Change of Use
<br /> DESCRIPTiON OF WORK: e\P• 4 CSS rw4G,C.
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> j`1014-0 4:0.4 hili ITTAPP1libl tiQN ' s =,ru, PLUMBING PERN11'f'AOj L C' 'ta t ," O?r i-
<br /> Type of Project: New Addn ,Alteration Repair Type of Project: New Addn Alteration _Repair
<br /> #of #of #of #of
<br /> List of Fixtures List of Fixtures List of Fixtures list of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures i
<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(ServiceBar/Mop/etc.), Other:
<br /> 74.01k
<br /> KEER,IaURPRES$10ggSYSi'EittPt
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT:l have reviewed this application end 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 properly to perform the work for which application is made,
<br /> and'comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> PERMI Ma
<br /> dA3 S • e�
<br /> Ownerl uthorized Agent Signature Date (Revised 10/9212015)
<br />
|