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PERMIT APPLICATION
<br /> dBUILDING/ MECHANICAL/PLUMBING /SIGN /SPRINKLER/ DEMOLITION
<br /> CITY OF EVERETT PERMIT SERVICES
<br /> 3200 CEDAR STREET,EVERETT,WA 98201
<br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits
<br /> *424 i- a IN ' iiikx, 'nI! e l ,rlY, 'wm1! Ei1 i �a t*ft- —*0I .1 tu 'WP.. di vmr r �P-
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<br /> PROJECT SITE ADDRESS: i 4 \\ e___„,,,,,,, g...A ei PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> �!:''1 IfR r C, p , r 3. Si ii c N4+? w.;. MyA, v a rqlhl Iii ' ii! I t � � li i�l iI 7 1 i
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<br /> OWNER NAME: \ �Y �1
<br /> TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET I4— vV aks(_..P' J l.-d
<br /> CITY eq•Q�Q STATE 1A1,1.— ZIP
<br /> ZIP I 42 4
<br /> OWNER PHONE: l • OgOWNER EMAIL:
<br /> CONTRACTOR NAME: 'OI��, -1-1/4,,a; i +6 & ( (�(,�6v.
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<br /> CONTRACTOR ADDRESS: STREET f O��h 'i pli g �A
<br /> �f CITY & ��nI((( vL LA. STATE WA ZIP 9g[ri0
<br /> CONTRACTOR PHONE: .p()-/-,0 -6 .1S CJ CONTRACTOR/� EMAIL: I� (fOc„P.-� af/An
<br /> CONTRACTOR LICENSE#(REQUIRED): P C-(tal03Z-+�r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):r` � J ✓�
<br /> , ,-,, , „ __ ,.w. ... . . t , u, ., r -, �� , _, , ti - _ -. �. .. _PRIMARY -
<br /> CONTACT: 0 OWNER KI,CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: tN.00 , le ct . 6:160
<br /> 3,u(ANA 6P-e.\n6k-r) CONTACT EMAIL j 11f,\
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<br /> . 4t, . An " rin Zl3BIIgPER T APL CIO �,.
<br /> .-:.:74:**1;::
<br /> Existing Use of Building: Contract Price of Work:$ i wLJ---
<br /> Proposed Use of Building: Heat Source: Gas ❑Electric ❑Other
<br /> Building Type: ❑SFR-Detached KISFR-Attached ❑Duplex ❑Multi-Family-#of Units: El Commercial ❑Industrial
<br /> Type of Project: CI New ❑Addition ❑Remodel I Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WOR
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> .�r u t ,PI:uMBING3PERMIT APPLICATION . I w.��4��i� ."
<br /> wCHARICAL 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 #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 /> I 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 /> __ -Ro KL*J SUPPRESSION SYS'T'EM
<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 .mply th- . at: ontractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
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<br /> Ib [(a PF # gl0 .- [O9
<br /> Owne ut •r¢ed ••ent Signature Ddte (Revised 9/23/2016)
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