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grrPERMIT APPLICATION
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRICknji.
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<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa:gov www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: /I I Ito ,.jl (A)J PROPERTY TAX#:/1/')(�1/'GJC! (C?
<br /> LEGAL for new construction: Short Plat/subdivision J W Lot No. (�J r(atttacch Keil' copy of long legalrdescription)
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<br /> OWNER NAME: (Ckfld\\C f (vt TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET .✓L 9,l r I 0 R, �f /j��
<br /> CITY t/./V 2fl [ STATE ✓t ZIP /A J
<br /> OWNER PHONE. 31 -e7OWNER EMAIL:e /' Xf�icee aj aI C f/ ,
<br /> CONTRACTOR NAME: L ,�/tQ i� Ie
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<br /> CONTRACTOR ADDRESS: STREET'1'`1D V
<br /> .141 c'il- 4.1
<br /> CITY Plaor iaV ...1?I / 2 e STATE( % l� ZIP vra
<br /> CONTRACTOR PHONE: 2t-1-1j -1 IJ'4 CONTRACTOR EMAIL: info 6 n,C�e 'gruo.„0 .e rj
<br /> CONTRACTOR LICENSE#(REQUIRED),. 1 ,(j EE 3 (� CITY OF EVERETT BUSINESS LICENSE####(REQUUIIRED)O 77q J
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) ___Illaaa
<br /> CONTACT N ME: CONTACT PHONE: L/2s I -- 13'
<br /> flY a V 110 , / , CONTACT EMAIL: info ® 'e � 7,0' J ,, e ( 1
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<br /> BUILDIN ER 1 _ 'l ..,
<br /> PP .I,CAT1 -
<br /> Existing Use of Building: �� �� Contract Price of Work:$ [7C L.f J
<br /> Proposed Use of Building: Heat Source: 46as ❑Electric ❑Other
<br /> Building Type:JVFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel ArRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> \\U cls NnO: nclCC "61q- Oc .
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT APPLICATION= , g 5 PLUMBING PERMIT APPLICATION, „
<br /> Type of Project: _New _ Addn _Alteratior ,Repair Type of Project: _New _Addn _Alteration _Repair
<br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> I 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 /> 11411),;, , 01- S!161hiinaa �ar
<br /> I 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 aI,thorized under any circumstance.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made,
<br /> nd I comply with the .tate C'L!trac ors L- 18.27 RCW and 296.200A WAC.
<br /> j ' r City of Everett Official Use Only
<br /> PERMIT#
<br /> , 1 lig22__ r goa-oA-
<br /> O -'/'eR yr.. 3Td Amt Signa . e 7 Date (Revised 10/12/2015)
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