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&&O K
<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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: L2 i c f� ' 4iie SE Veret/ (Jp (8 �Q PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. t(attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Ai rKrv1/t (, f TENANT NAME(If Commercial): .1,«r1ct(L I �{,t4
<br /> OWNER MAILING ADDRESS: STREET (,.,2/j c' 0/I^ 4v 56,
<br /> CITY G" ,,,,,K f'" STATE 08 ZIP C3S;y A.
<br /> OWNER PHONE: I-1,2.5-- 7 ~ 3 OWNER EMAIL: ver1,,rl
<br /> CONTRACTOR NAME: )=." r' U
<br /> CONTRACTOR ADDRESS: STREET ( J
<br /> Ci 9�1:� } c+
<br /> CITY A-( ,,,p.,el r1 C., STATE V f - ZIP 73 3 ii,"
<br /> CONTRACTOR PHONE: ^](7 -- 1-lie(-0j 3,:ft I CONTRACTOR EMAIL: ,,-+ -
<br /> (,C,11'-'t' i" (7:2) � (i);,t(�r s
<br /> , it7t'Y s
<br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#{REQUIRED , r- 3
<br /> PRIMARY CONTACT: ❑OWNER ok CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: /1 /16 ..,i r.- CONTACT PHONE: -/�� _ r..-/62 97✓ 4 CONTACT EMAIL: .43( s,,.r• 4(a, SC Ce„t it v'-.t : 6,t-)r
<br /> 41
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$____11:21. 0-60
<br /> f
<br /> Proposed Use of Building: Heat Source: ❑Gas lectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial Dindustrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: 0 1�r
<br /> e 3°'Z'olkaC, 10"C"Ot (A)4"Cc Ue.5 v,),Aki, ‘3c9(
<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 #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump a LI Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater j LI Bathtub Urinal
<br /> Gas Piping Boiler , 4 Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove 1 Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting ( Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: f Clothes Washer Medical Gas
<br /> Range Hood Water Heater ,l, Other: //t r f)rG,4
<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.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 th- ..: .ntract. 27 RCW and 296.200A WAC.
<br /> �'~� (�/7/
<br /> City of Everett Official Use Only
<br /> / CJJf / j I PERMIT#
<br /> VVZ\0 — 00(.0
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