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PERMIT APPLICATION
<br /> BUILDING/MECHANICAL/ PLUMBING I SIGN/SPRINKLER/DEMOLITION
<br /> 4.577
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 I FAX 425-257-8857 (E)everettepst everettwa.gov I www.everettwa.gov/permits
<br /> ' PROJECT SITE:INFORMATION ;''
<br /> 202 L 2 SITE$DDS SSr r c v�R Err-
<br /> S' PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> ,CONTACT.INFORMATION ,.:.1':: ;':
<br /> OWNER NAME: 6 41,1.w/1-l—Gi„e,44- L. TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET .2( 3 1/C Tr' ST /Yr 7,.
<br /> CITY Aja.. 5 1/I*L1 6" STATEV1.4/* ZIP c -2 7/
<br /> • , - =_.0,11 : OWNER EMAIL:
<br /> CONTRACTOR NAME: 2 /$1,4-D !3•f-h bX41. ,L' v942 CAI r,e'C- $
<br /> CONTRAC •- 'DDRESS: STREET 2 ( 2 a 41rA ; ✓t zS , c tit're tzo t]
<br /> CITY 74.0.4) r STATE 1�4 ZIP q d"d 31-
<br /> CONTRACTOR
<br /> Z,
<br /> CONTRACTOR PHONE: 02 63 q t� -W/ G, coy RAJ TOi 'AIL: .1-.$1.4-b�6,y(3 Aiec T,�'C rS.�'a,�
<br /> CONTRACTOR LICENSE#(REQUIRED): T 'h� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER .l CONTRACTOR , •T -se Specify) /9/2�� 1 T,.�,7—
<br /> CONTACT NAME: �..Z'/�?A,(b 4,�t, ip�¢ / q CT PHONE: 2j 3 L/6 `76 c
<br /> O/ / ONTACT EMAIL: t [ +—
<br /> O Cr� ��/�ti ;1 ✓ /yf/Q/S ��!�i�1►2 C'.�7'TL�`�I s Cc}h
<br /> -:.,:_--,-,',.-,,,,-1', _ BUILDI , G PERMIT APPLICATION,
<br /> Existing Use of Building: S7,t(Qi _ F„t A.7,Lf,/
<br /> _ Contract Price of Work:$
<br /> Proposed Use of Building: S G-/e rf>R,ti i L y Heat Source: ❑Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detache ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial El Industrial
<br /> Type of Project: ❑New 5 ddition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler El Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK. rr
<br /> Re Model R- P D , T ••OA( col w X. Sp Xl(r-- s TRU cT (X- t'
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICALPERMITAPPLICATION:- ;PLUMBING-PERMITAPPLICATION
<br /> Type of Project: New_ Addn Alteration Repair Type of Project: New Addn Alteration _Repair
<br /> #of List of Fixtures #°f 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 /> :SPRINKLER/SUPPRESSION.SYSTEV[
<br /> Number of Heads
<br /> ACKNOWLEDGEMENT:!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!am authorized by the owner of this property 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 /> +�
<br /> �j City of Everett Official Use Only
<br /> [—2'-17 PERMIT�
<br /> & &®G[ 0
<br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015)
<br /> ,ms',µu, e-A.A reC T5
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