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<br /> PERMIT APPLICATiON
<br /> BUILDING/MECHANICAL 1 PLUMBING/SIGN I SPRINKLER/DEMOLiTION •
<br /> *4177CITY 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( wwweverettwa.gov/permits .
<br /> (flue.®r-iskackc Ink®.njy.Pfease • : . PRO,'MO'-Myt INFORMATION •• • •••
<br /> PROJECT SITE ADDRESS: 3 31 0 C. D few ( +PROPERTY TAX#: p ' DBD 2
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> - •_ . .CONTACTT 1P®iiVII1 TION . .. . . - . ... • • • .
<br /> OWNER NAME: eliMir `1-, NA.b-r TENANT NAME(If Commercial): , e,44/44414-
<br /> OWNER
<br /> e /4f4'7OWNER MAILING ADDRESS: STREET `3.3(0 p •
<br /> CITY EOQ-0`n- STATE JAM" ZIP GG/f
<br /> OWNER PHONE:'. r12 '.. ;.:;'Un .( ��..T'... •••••-----.}OWNER EMAIL:.,. .,,.. .,.,,,....,,...,..,-,.,,,.... ,.,.,..m,......,..,., ,,.-. ,,. ., ,...,m._ .,... ,._ ,
<br /> CONTRACTOR NAME: EUt;•Yc.0 �,, J Tc m -C-
<br /> CONTRACTORADDRESS: STREET x(2,0 (it.t AU e" ,
<br /> CITY S U WUTT STATE (,4J _ ZIP /SOO(
<br /> CONTRACTOR PHONE: q`ZS'
<br /> 5-2- 2.P3((14 • !CONTRACTOR EMAIL: Mii
<br /> 06 . SS5,alA £ '\
<br /> CONTRACTOR LICENSE#(REQUIRED): E('G/24.5S 02.2_0`"- !CITY OF EVERETT BUSINESS LICENSE�t(REQUIRED): & 6-/ty 5-
<br /> PRIMARY CONTACT: 0 OWNER 129.CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 42Sa2ST2.- //f1
<br /> Mt ' ift CONTACT EMAIL: A r / L 5-3.0141e,14 6e190
<br /> _ BUILDING PERMIT APPLICATION • ' . .
<br /> Existing Use of Building: Alt C �' i Contract Price of Work:$ /1 ���
<br /> Proposed Use of Building: No e' m Heat Source: ❑Gas DElectric ❑Other
<br /> Building Type: ❑SFR-Detached OSFR-Attached ODuplex ❑Multi Family#of Units: 124Eommercial Cilndustrial
<br /> Type of Project: ❑New DAddition ❑Remodel [Repair ❑TI. ❑Sign ❑Sprinkler ❑Demolition QChange of Use
<br /> DESCRIPTION OF WORK: L k .,.z.•T0/1/4/ /o-fo f upo t' iv/sNoP o 2_ 1
<br /> nw
<br /> 11
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> Ii4ECHANIGA!PER MITI'APPLICATION . . . PLUMBING PERMIT APPLICATION
<br /> Type of Project: _New Addn Alteration Repair Type of Project: New Addn Alteration Repair
<br /> °fList of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C-Air Handling Units 1 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 HeaterRefrigeration 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 /> •SPRIISIKL,ER/SUPPRESSION SYSTEM
<br /> Number 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 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 WAG.
<br /> City of Everett Official Use Only
<br /> PERMIT pi\(..c-coz
<br /> (.42)‘-
<br /> Owner/Authorize ent Signature Date (Revised 5/20/2016) a— Ng ,,,illi
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