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PERMIT APPLICATION 'U_ 0 D
<br /> 0,0p.
<br /> BUILDING / MECHANICAL/ PLUMBING/SIGN/SPRINKLER/ DEMOLITION
<br /> viii
<br /> 1M 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 I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: I // iCi 41, 4,e SE C v t,Ai- (A)0 d 1Q PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: },V,I;in Cn;,n TENANT NAME(If Commercial): S,1,,,(kVA= 1-4(,�-5
<br /> OWNER MAILING ADDRESS: STREET (,,;j/ ' /�i fl, 4, ,r,-,:-.„ f
<br /> CITY C" tr•(K.fi- STATE /A zn' _�8;7) /')
<br /> OWNER PHONE: Li..2 ss" 33.7 - '` 3"j OWNER EMAIL: `) Iger l,,V,.,'0, t' () ` ,i,,,,„,, „,- ` ,,,,
<br /> CONTRACTOR NAME: St A, �(,),a4e f (I U
<br /> CONTRACTOR ADDRESS: STREET
<br /> CITY A(lam'/7(L�,,l ci n CA STATE kith ZIP 2 3/I'1
<br /> CONTRACTOR PHONE: -70 3 -- (-He(- 03 Litt CONTRACTOR EMAIL: $(t-,U-...i;r 6,--i, `>.+ 1) ,. I , ,:„..,-}„,/
<br /> CONTRACTOR LICENSE#(REQUIRED): p`� ,f� lr
<br /> t l -�)� �'�`v} ��� �(,, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �'j r)
<br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: Cod„krCONTACT PHONE:
<br /> CONTACT EMAIL: ,: t,,,,.....kr e; SC�cC2t=r:.h” , C.it rYt
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ 4 ((pi 5-00
<br /> Proposed Use of Building: Heat Source: ❑Gas Iectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial [Industrial
<br /> Type of Project: ❑New DAddition ❑Remodel ' Repair 07.1. ❑Sign ❑Sprinkler ❑Demolition OChange of Use
<br /> DESCRIPTION OF WORK: 0 r I tt !! { t t�
<br /> ep`c`-e ?L`'( V)./ 1fJi� ,("^�L 6):4--<r \I�1C,s ,,,),'Ili F,: 7(
<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 /> Fixtures List of Fixtures Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures
<br /> NC—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 1 a, Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting la Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: i a Clothes Washer Medical Gas
<br /> Range Hood I Water Heater ,1 Other: Uwe_(w,b
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/SUPPRESSION SYSTEM
<br /> Chemical or Water ( 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.lam 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 Contractor w 18.27 RCW and 296.200A WAC.
<br /> / City of Everett Official Use Only
<br /> 7V<,..,/}jrr.orw..._ .87.7s
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