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PERMIT APPLICATIOPI
<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 /> {BCru HBlack In ,,O nly.Please) ,PROJ T,.S.IT:,��INFORMATION <, ';y, o .....,,
<br /> PROJECT SITE ADDRESS: 510 0`' (.bi+nt•-L. 4tC a4C I 4i C/t1 ' 1g2PROPERTY TAX#: tiqc-VI)(?Q 2. ?ooc c
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFOt j 11AT1 N
<br /> OWNER NAME: 00., c, 1`^7 Ar tar,\ ,iirn lf'\'1 C1 J) TENANT NAME(If Commercial): r1 tet....
<br /> OWNER MAILING ADDRESS: STREET 5 ,G)04 t otV .-cCrL:.c..Q,.
<br /> cnY i.,r(i STATE W,1 ZIP 2'203
<br /> OWNER PHONE: Li 2..S 3'-k t, . 1(o b� OWNER EMAIL:c)c c r�5 . O-r-:-4ivas- ,ANAeAlY\�61A,,t•Ctm
<br /> �, „ ,. .._ , „sw,, , ,„,do ha,,,„ ten._ ,
<br /> CONTRACTOR NAME: 1?A,C l•1�l C, Ear"tele-S
<br /> CONTRACTOR ADDRESS: STREET '?-.c)b4 CO`�j� I ){
<br /> CRY ��l•V` STATE ZIP a y"�D t
<br /> CONTRACTOR PHONE: 4-1.2. ;--443S;--443IL{ Q' CONTRACTOR EMAIL: ,0 i il:S DY1 ?a,.t v'Vz c,Aar rAcieS• LoAN
<br /> CONTRACTOR LICENSE#(REQUIRED): V p5 , \G&I . �$3 N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): e:. _ 3 5
<br /> PRIMARY CONTACT: 131 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: tr^^ CONTACT PHONE: L4 34l<,fj(Q to"Z
<br /> J0. v't' 7^,uv a'�V1n0.f �C� CONTACT EMAIL: � McPJC„r,rocc. o,v s01,�w •+H.Mf1lL NAI/•UB vh.
<br /> :BUIL`DING P RMITAPPLICATION
<br /> Existing Use of Building: Contract Price of Work:$ 31 ,•11'1)
<br /> Proposed Use of Building:CI cyrcke. , Heat Source: ❑Gas ❑Electric DOther
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: IPNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK: ,tn
<br /> o yGr v�C. O c�a r w v dt�'� uJv 1 h cg ... b..FC-1-1 �u•.�/-.c, Po t r\ k lry o-k ,vf'/ -t'
<br /> v..Q -}•• ,n., �•w�- �e cv pc -o9 �T((2„v .yf \(\vis -tom--\ L'l9\Wv.�e4 .
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): \l \`-'� 1.►
<br /> 00
<br /> '`, ,j=ME HANICAL PERMIT„ ►PPLIcATIQI+I >, tPLUMBING PE IT 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 #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC—Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> 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 /> Exhaust Fan - Sink(Service/Bar/Mop/etc.) Other:
<br /> ; ”`4PRIINKI ERS 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 /> ^ ��,� �7 City of EverettJOfficial Use jOnnlly
<br /> C ^�/'�r'-tifl C J `tom '/ � /� PERMIT#/1 1, -1 o -1 - 0,g/ 0
<br /> Owner Authorized Agent Signatur Date (Revised 9/23/2016)
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