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<br /> PERMIT APPLICATION
<br /> BUILDING /MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<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: i jrc /ci-11" 4t,f r �j. ` !(��± t PROPERTY TAX#:
<br /> �� d{�PfPll G/YI 7��,�
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: 14"1(r),y1 67 n.�p TENANT NAME(If Commercial): ,1 ,P11OKr (-Iiii-5
<br /> OWNER MAILING ADDRESS: STREET ((( '//c /g/I^ 4v, 3
<br /> CITY C,trt fi'frt.-- STATE 1)8 ZIP 98 (.),
<br /> OWNER PHONE: 1 ,,j—"' ll�7 59,s 3 OWNER EMAIL: c) t LA(. ,r yr
<br /> ..... _.:�v.1 . . ...`J' , '. .. . •1`IVf Z',r�4lt�f- t� C�..�"��1�1 43"+`�, /�)G?'I
<br /> CONTRACTOR NAME: Sr,-)G(), e r'
<br /> V
<br /> CONTRACTOR ADDRESS: STREET I 3 G, � --
<br /> �� 'l�U��f-A-Girl
<br /> crrY A /Xt,\Jt('1tic,. STATE V i_ ZIP a 31L/
<br /> CONTRACTOR PHONE: ^](7`1--- 1-1/2(-( Lf9 CONTRACTOR EMAIL: 3(x,—f r L"), ,;"c U),,,t1,f-r i:,,:nin
<br /> CONTRACTOR LICENSE#(REQUIRED): t t \),Ji(\¶3 9 4 se, CITY OF EVERETT BUSINESS LICENSi#(REQUIRED): ,5-0,,,3 l5
<br /> PRIMARY CONTACT: 0 OWNER XCONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: r Cki 4't CONTACT PHONE: --log--- .2;I /62 L{/
<br /> CONTACT EMAIL: `)(.C..st tQr t 5LsC s,t r-Az r', ("i)TO
<br /> {
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ 4((p(5 Q n
<br /> Proposed Use of Building: Heat Source: ❑Gas lectric ©Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition CI Remodel Repair CIT.!. ❑Sign ❑Sprinkler ODemolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ^ j
<br /> IC (:,``c'r e POS LAti.tI.c/lC, r,)\-ckaL u)cA--t �tvn@.S vJ,'\*n P VX
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMIT'APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration Repair
<br /> #of #of
<br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump j Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater jBathtub Urinal
<br /> Gas Piping Boiler 'l ' Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove I Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting j a Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: (a Clothes Washer Medical Gas
<br /> Range Hood /a Water Heater cz Other: (. P /3;b
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER I SUPPRESSION SYSTEM
<br /> Chemical or Water I No.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.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 wit State Cont,,, Law 18.27 RCW and 296.200A WAC.
<br /> AO
<br /> Q / City of Everett Official Use Only
<br /> �i�'" /"� U77 l s 0 P TT#
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