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PERMIT APPLICATION GL 0 G
<br /> BUILDING/MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION
<br /> #S047-' ---A
<br /> vitit 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: /a ITS /Ci lin 4 t,P SE fvt, ri PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: A k,/;,vi 6,..10 TENANT NAME(If Commercial): ,1 «,,4,,,k. (4 f f, 5
<br /> OWNER MAILING ADDRESS: STREET /,..2//,(:-. /9 it, 4v' 55 I
<br /> CITY tr'fr i- STATE (4a6 ZIP 3S,(),.
<br /> OWNER PHONE:
<br /> I-1;J--- 1 - 5?313 OWNER EMAIL: ,( LAC a'6e....r. fi; t: , .
<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET i 3 ,,,, �G n Si,
<br /> CITY a ..,0,,,el nG. 111 STATE VA ZIP ) 3 IL/
<br /> CONTRACTOR PHONE: �(7?) L'�7(- (� 9 CONTRACTOR EMAIL: $(I t -e r r,.; .,( 0) ,.� Yr �,),,,ti
<br /> CONTRACTOR LICENSE#(REQUIRED): R,.L),�t 17 5 `� �J (;, CITY OF EVERETT BUSINESSIL✓ICENSE#(REQUIRED): S25,3 J
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: jilCONTACT PHONE: 703/_ ,: (_ Ii. i/
<br /> CONTACT EMAIL:
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: /PIJfi,' `F' P1. / Contract Price of Work:$ *16l<on
<br /> Proposed Use of Building: Pin v(4i ,.••••d 1 y Heat Source: ❑Gas lectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached/ ❑Duplex ❑Multi-Family-#of Units: 12 ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: lk-e)'c,ce cWi i VfiLk i f G r.-(-A\O (,)4-Q- UC'.5 u,,iAkt, Yc9(
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL PERMITAPPLICATION 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 #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures
<br /> A/C—Air Handling Units Heat Pump a9 Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater a L Bathtub Urinal
<br /> Gas Piping Boiler a yi Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove l gKitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting to Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: /a, Clothes Washer Medical Gas
<br /> Range Hood is Water Heater a Other: Apse g,b i
<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 with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> I PERMIT# I
<br /> F130 — 0 30
<br />
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