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PERMIT APPLICATION
<br /> /41 ----A
<br /> BUILDING /MECHANICAL/PLUMBING /SIGN/SPRINKLERS (TION
<br /> CITY OF EVERETT PERMIT SERVICES "IAe
<br /> G'
<br /> 3200 CEDAR STREET,EVERETT,WA 98201 •11��
<br /> 6 JJ'' (P)425-257-8810 FAX 425-257-8857 (E)everetteps@everettwa.gov www.everettwa.gov/permits
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<br /> ,...-.s" .,�+i)d ��� � .y 40*�+2u �' m., .,.�' v� ��y a.._ . �: s� ��. � -az:_.= �. _ '� ,4'F��'
<br /> PROJECT SITE ADDRESS:rG 1,typ., crSc4PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision /� `fir Lot
<br /> No. r(attach copy of long legal description)
<br /> '1,114:',: �i. rz ti -'4-i .� K, .*.. . �.'vr tl. - 07:41 � INF 0RMA OI\ dii �f' -�. ._+a5...- r�.,r '---_,V-
<br /> OWNER
<br /> ",€.�.V
<br /> OWNER NAME: t. (Anit 4/1[e 6 v1/ '�i(�----- TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET( /62— 1`�111/,
<br /> ^ c S _, ' r ^/���
<br /> CITY /i' ./ , —J1 STATE .. �,/ , ZIP 01;-�j LJA)5
<br /> OWNER PHONE: 2/(12,6( l L.Q. 3 OWNER EMAIL: V
<br /> CONTRACTOR NAME: 0,k,j ��,e,t,w�Je/
<br /> CONTRACTOR ADDRESS: STREET 7 ( I Le 2,12 5'r/v /4-'1�
<br /> CITY AA L. ( V STATE V ` ZIP' fro
<br /> CONTRACTOR PHONE: 1-4-12 .--11 1.1 l ¢ CONTRACTOR EMAIL: b \ `.C1 }
<br /> CONTRACTOR LICENSE#(REQUIRED): V�S-M.Q CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): be Z"] IC
<br /> PRIMARY CONTACT: 0 OWNER ONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: /4-2,-c.7'1 /..--11 13 ci
<br /> i__cA,) 1 G�L 3 t'2 CONTACT EMAIL: t
<br /> _ ��sa l pk�e'�ataPVNAMrs d et a. � '4 '�` -� �b�P�Vi �w� -'�1J�1� "s �.:,'
<br /> �UILPING itrki t Apptl cAt—ON �,
<br /> Existing Use of Building: Contract Price of Work:$ `1 l l7U
<br /> Proposed Use of Building: Heat Source: Aas ❑Electric ❑Other
<br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: ❑NewAddition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WO
<br /> lk (,. A 8 c cv
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> AgtMECHANI:CAL*ERM_If*00:01 #10:43::" RRR,Ci . air fPLUMBING PERMIT APPI ICa$' iol Y` n'tY,TW,
<br /> Type of Project: _New AddnAlteration Repair .- of Project: _New _Addn _Alteration Repair
<br /> #of List of Fixtures #of List of Fixtures #°f List o xtures #°f List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> NC–Air Handling Units Heat Pump Toilet ckflow 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&Dispo Grease Trap
<br /> Gas Range Ducting Dishwasher Roof Drains
<br /> Clothes Dryer Hookups Other: Clothes Wash= edical Gas
<br /> Range Hood Water He. --r Ot r:
<br /> Exhaust Fan Sink(S- ice/Bar/Mop/etc.) Othe .
<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 mus omply 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 /> nCity of Everett Official Use Only
<br /> 0 x�jn / 1 U PERMIT It I 1 I' (b 027D1
<br /> Owner/Authorize ent Signator , Date (Revised 10/12/2015)
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