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PERMIT APPLICATION
<br /> BUILDING I MECHANICAL I PLUMBING I SIGN I 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 I www.everettwa.gov/permits
<br /> ... _:e= . :_: __,: P.-ROJECTSiTE1NF i MAT1ONA.:' M___' _ci,__ .:_
<br /> PROJECT SITE ADDRESS: PROPERTY TAX#:
<br /> 1711ak,-(,, s -
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> >._, . -_.:-:.CONTACTiNFORMATION; �,:?,_ .-� ,.�.;:Y, ..,a,Exi. : .,_.:
<br /> EMERVERES
<br /> OWNER NAME: ! cL 7 ' 6.) [la,e4 TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET J``) / ) ,a..(4_(„\ 54-
<br /> cnv , ....,,,e,,,,,,,__-R-- STATE (,.4, ZIP 9
<br /> OWNER PHONE: Li'0--5-
<br /> — 5GI `...1q
<br /> 1 5L1... OWNER EMAIL:
<br /> ...eiClktt>.\/a eturkill, ',1 AV - .. .
<br /> CONTRACTOR NAME: Ousel- 3oc j/Ok. 6.c.<__ 61)0 t/'k S
<br /> CONTRACTOR ADDRESS: STREET '30 32 (:' 2 6&-� q✓ ivw
<br /> CITY 546^catl06/ STATE ((,Q, ZIP ./
<br /> CONTRACTOR PHONE: C-
<br /> 1 5--...--}16,—0 L/'7CONTRACTOR EMAiL: id�.g-j-5apiQ54„)',jaw`{S j) • t ->.CONTRACTOR LICENSE#(REQUIRED): (ise4-j5 co5 1 N(,) CITY OF EVERETT BUSINESS LiCENSE#(REQUI' D):
<br /> PRIMARY CONTACT: 0 OWNER QONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACTINAME:
<br /> � 1( CONTACT PHONE:-.if ,, fps-it/4_0 s,,, tr/4_0 l(1�7
<br /> Need 1 / �a`^\`L� CONTACT EMAIL: 'nJ to _SO C., - 7• e► .�o2"C,r/lct.c((40 c .
<br /> - BUILDING,PERIIIl11T:APPLICATI,ON __. ,F ,:x'.,n ..4**:N SkY kika4-.-..__ii
<br /> Existing Use of Building: Contract Price of Wor $ S.c0.. O 2 ,
<br /> Proposed Use of Building: Heat Source: ❑G.s ❑Electric ❑O --r
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family#of Un's: 0 mercial ❑Industrial
<br /> Type of Project ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Spri ler 0D-••.l ion ❑Change of Use
<br /> DESCRIPTION OF WORK: ,D
<br /> AdA 0" 5a) ) e -0p" V\d
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> ��apK� .._�.__.. ti 4 .. L i _n-' .,.,>„ f is mow,.:-,.,...,. ,�-a:4 �+�ie"'1.y,ti:
<br /> t_ MECRANICAL#ERtVi� 700: KATION_y.,;,.,.__ ,_ - .. „ -n,..;, :PLUMBING;,,PERMITrAPPLit".►ATION; . „ _v._.ur,;,,.
<br /> Type of Project: New_ Addn Alteration _Repair Type of Project: New Addn Alteration _Repair
<br /> #of #of #of . #of F
<br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures
<br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> IForced Air Systems Unit Heater Bathtub Urinal E
<br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain 1
<br /> Water Heater Refrigeration Shower Floor Drain
<br /> Gas Fireplace - Wood Stove Kitchen Sink&Disposal Grease Trap
<br /> t Gas Range Ducting Dishwasher - Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas 1
<br /> Range Hood Water Heater Other: 1
<br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other:
<br /> 1
<br /> r SPRINKi4gl SUPPRESSiUN SYST iV(W1
<br /> 1 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 i am authorized by the owner of this properly to perform the work for which application is made,
<br /> and 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC.
<br /> City of Everett Official Use Only
<br /> Pr\if(eR4 sp. 0 s (42
<br /> Wl/
<br /> d Agen S •nature Date (Revised 90/92/2095)
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