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4ren- 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 I(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION
<br /> PROJECT SITE ADDRESS: J , I 7_4_11.7 LA 511-1 ,PROPERTY TAX#: 0'1)6 3 3c-LS p i,,yJ
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> CONTACT INFORMATION
<br /> OWNER NAME: kc-h-,'r i•GL Z__ Cas. i ,,-1 TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET j9;',.... (,),-__%9 Sill
<br /> CITY E-✓e-{�f'_jiL STATE W74) ZIP g&._, CD
<br /> OWNER PHONE: �f, 5---m;0 Tl' / OWNER`EMAIL: / C.,,„,n �Lf{n&i 1, Cin v1
<br /> CONTRACTOR NAME. 1�1 ,'�lt' /41 t j, - GLu/L�k?i/ LS GLI ►k (s UiYL- fir-led YU�L
<br /> CONTRACTOR ADDRESS: STRE ---- - - `�
<br /> CITY `-5- STATE"-14- ZIP C-F___
<br /> CONTRACTOR PROM= e 7 Z t 76 U= 1 TRACTOR EMAIL:,5 - (.
<br /> CONTRACTOR LICENSE#(REQUIRED): C Lt IC2,2 CITY OF EVERETT BUSINESS LICENSE#(REQ,'IREDI;_ -
<br /> PRIMARY CONTACT: K, OWNER 0 CONTRACTOR 0 OTHER(Please Specify) -i,, ... .....,,,..,.,1,...:,..„ ;
<br /> CONTACT NAME: CONTACT PHONE: 9,25.76 0 /rr
<br /> ict): l y C-4l:i CONTACT EMAIL:ea*/ C-o.s v..‘0,-v..‘0,- 1'O-Jh'l&i I, C -,i
<br /> BUILDING PERMIT APPLICATION
<br /> Existing Use of Building: Fri h,1Y jam„ Contract Price of Work:$ 7_0/-i "4-> — / i‘e---/
<br /> Proposed Use of Building: P1,--,,.,n it.,/ /10,., S f K Heat Source: El Gas ❑Electric ❑Other ArtY
<br /> Building Type: NSFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family #of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑New DAddition at'Remodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> ASSOCIATED BUILDING PERMIT#(if applicable): ?ek Obi I EA 1 CA1 V01/1°", U)I l I ne-e-C` ) o Y✓-I v f er'mLf
<br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New _ Addn XAlteration _Repair Type of Project: New _Addn A(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 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 j1 Kitchen Sink&Disposal Grease Trap
<br /> / Gas Range Ducting I Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas
<br /> _ / Range Hood _ Water Heater / Other:/4,:a",,,,- /i r,c 4o‘,-',Tc e..
<br /> _ i —Exhaust Fan _ Sink(Service/Bar/Mop/etc.) Other:
<br /> SPRINKLER/ SUPPRESSION SYSTEM
<br /> Chemical or Water ' 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 /> (--.---: 4 _ PERMIT#
<br /> �` (-[$O7 -- oil -
<br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) it
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