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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL 1 PLUMBING!SIGN I SPRINKLER/DEMOLITION
<br /> "Ill'#<4‘%/4:::i CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 J(E)everetteps@everettwa,gov I www.everettwa.gov/permits
<br /> BigCal;,BJacklkAfittPlease -;n, PROJECTSIIfE INFORMATION,,,, _; :: '-'""`-''
<br /> PROJECT SITE ADDRESS: 7/L/ 4,-"O�g,/,4'//, PROPERTY TAX#: QQ/3c(/G 2."/ )0
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> .0=1 ..-<•:.:...,: 1 :-:,•AFA ...A.. ..,_.,. . e.O.O,NTIICT1. .. . .. ...... , � ..... . _._ .,_....._-r_ __.._.-_. ....... _. _....
<br /> OWNER NAME:Te.Ko L It- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET LI /33 g 12,z v i P t `✓.
<br /> CIN ;: � 'F '�P - STATE ‘..„./yn..�_ ZIP C( Z- t
<br /> OWNER PHONE: I Z IT- 737-0076-- OWNER EMAIL: I
<br /> CONTRACTOR NAME: 6-frS I-{e 7'J1t•1 q .
<br /> CONTRACTOR ADDRESS: STREET 3809 Cveye'ti
<br /> °WY ElAare'Cr STATE k,,,,,A ZIP ($20 1
<br /> CONTRACTOR PHONE: 2'-3o,21- 64-17-7 CONTRACTOR EMAIL:Tey ' GSKPraaTrVIS.0 Olti i
<br /> CONTRACTOR LICENSE#(REQUIRED): 65 ( g °qt�R K CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):l g6gs-
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: LI' ' 3 400(-65-0 7
<br /> Te v2yt.c F 'r r CONTACT EMAIL:-a'0140714 4-61-fpy1t
<br /> tis . C
<br /> _..'... }BUiLDIING PERMIT'APPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ z_574,--pc,°-9-
<br /> Proposed Use of Building p1 az,4 <'ir60 Heat Source: fillGas ❑Electric ❑Other
<br /> Building Type: ©SFR-Detached ❑SFR Attached ❑Duplex ❑Multi-Family-#of Units: rCommercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition E!tiRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> -,), (......%,7 ,75- Cl/101'14i im an. 0
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .%ikz:,MECHANICAL EPERMITAPPLICATiON. ':_; :!; .,:a " PLUMBJNG;,PERMIT,APPLI.CATIO0
<br /> Type of Project: New Addn Alteration Repair Type of Project New _Addn Alteration Repair
<br /> #of List of Fixtures of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> I A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> 1 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 Kitchen Sink&Disposal Grease Trap
<br /> Gas Range ' Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other. Clothes Washer Medical Gas
<br /> Range Hood Water Heater Other:
<br /> 2 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other.
<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 the State Co flora Law 1827 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> -'.—)<.,%,./i/';af PERMIn 19)O2.
<br /> —f D
<br /> Oai`er/Ad"thbrized Agent Signature Date (Revised 9/23/2016)
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