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<br /> PERMIT APPLICATION
<br /> BUILDING /MECHANICAL/ PLUMBING/SIGN/SPRINKLER/DEMOLITION
<br /> '4j":‘ 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: /,2 jr,c i c3�� 4V e SE 61,@ reti (A)11 c.id,'}_PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: Ark,ii,Vi (J.. TENANT NAME(If Commercial): ,1„,,,f 1,i. ., jqrf-S
<br /> OWNER MAILING ADDRESS: STREET (47//c,' (9 fill 4 t, 56
<br /> CITY . U-' rr f/- STATE 00 ZIP (?-12 (i l!`)-
<br /> OWNER PHONE: -✓ 3 3 — .5, 3-j OWNER EMAIL: .•I�.rvr I,,v.e,,ti2,.- r 6) thy-'eta'f�;r r`f,r,
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<br /> CONTRACTOR NAME:
<br /> CONTRACTOR ADDRESS: STREET 3 Y l9 �n �
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<br /> (.1(k STATE 04 zip .3 114
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<br /> CONTRACTOR PHONE: -TO EMAIL:
<br /> �(7;� -., ��p('" f).�j`"��� ��(,qtr'-t' I cil 5-,:,(..-1,e•.U1taLer, C.,`ttrrl
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<br /> CONTRACTOR LICENSE#(REQUIRED): .A},i-,()) S 94; J (r CITY OF EVERETT BUSINESS LICENS #(REQUIRED): .5 rr5 3
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify)
<br /> CONTACT NAME: _ 1l(-- l II/
<br /> CONTACT
<br /> 06,,-4,,-- CONTACT PHONE: --7();/.
<br /> CONTACT EMAIL:
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ af-0150
<br /> Proposed Use of Building: Heat Source: ❑Gas lectric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition El Remodel Repair ❑T` .I. ❑Sign ❑`Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: Kr q, c-e c'v� L,A-LA 4f(1f c)6kc,1 6, -cs' `t'v\e.S vj +r• ijtz/j(
<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 List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump r7 LI Toilet Backflow Preventer(Inside Bldg)
<br /> Forced Air Systems Unit Heater , y Bathtub Urinal
<br /> Gas Piping Boiler a LI Lavatory(Wash Basin) Drinking Fountain
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace Wood Stove ti g Kitchen Sink&Disposal Grease Trap
<br /> Gas Range Ducting /8 Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: /i Clothes Washer Medical Gas
<br /> Range Hood f Water Heater a, Other: SC 6;hs
<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 ram 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 /> PE MIT# I
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