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I
<br /> GLO E
<br /> PERMIT APPLICATION
<br /> BUILDING I MECHANICAL/ PLUMBING/SIGN /SPRINKLER/DEMOLITION
<br /> 1' 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: r,,Z//,c` /9li1 4(,� SC /!'ver44 (,)n Fi),4 PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: f'Ic,K,I"V1 (7„-,) TENANT NAME(If Commercial): ,I,,,,.1 igf. i4r'5
<br /> OWNER MAILING ADDRESS: STREET (,,)rl c--; /9 7/4 4vt ,55
<br /> r$'OWCITY r:tr,l,p- STATE c,)6 ZIP 9 }r;s),s-
<br /> OWNER
<br /> NER PHONE: 11,2:5-. - 3.3 2 - 5,? - � OWNER EMAIL: �VPf � ('. b4� f" (i) r -1� 51r
<br /> 1 )(i"i
<br /> CONTRACTOR NAME: , r' �� �}
<br /> t
<br /> CONTRACTOR ADDRESS: STREET f 3 l 96:.4 XA--,,n .1
<br /> \9-
<br /> CRY A t , c t t1 o' n r STATE 04 ZIP 2,:q3 iii
<br /> CONTRACTOR PHONE: -0 CONTRACTOR EMAIL:
<br /> �7(�� -� Q(-c�3�t 9 3r.t-til---t' r � e5c., - 0,:,4r: Li,-,;rri
<br /> CONTRACTOR UCENSE#(REQUIRED): PO),,rt , CITY OF EVERETT BUSINESS UCENSE#(REQUIRED):
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: kat Jo f1 CONTACT PHONE: t
<br /> CONTACT EMAIL: r .�,, (ri)7i
<br /> BUILDING PERMIT APPLICATION f.:?,
<br /> "
<br /> Existing Use of Building: ./,({-T'- Frar,-,<<I/ Contract Price of Work:$ 4 f(r,t,5Od
<br /> Proposed Use of Building: /1,(“14-7--Fjy..yr7V Heat Source: ❑Gas 'lectric ❑Other _
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached /❑Duplex Multi-Family-#of Units: 11-- ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ^ j I
<br /> (( e'u(e vk 0,±-4 f4C ; ()U L (.04-cc \ v e,5 ,,,),Akr, Fid(
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): V
<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 Fiu List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures
<br /> NC-Air Handling Units Heat Pump (§ Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater i Bathtub Urinal
<br /> Gas Piping Boiler l Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove /j Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting /(g Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: /I Clothes Washer Medical Gas
<br /> Range Hood /2 Water Heater a Other: ({ase 8,`6
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/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 with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> �� �' City of Everett Official Use Only
<br /> a�J 7 f�a � PERMIT#
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