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4rEn. PERMIT APPLICATION
<br /> BUILDING / III#tHANICAL/ PLUMBING /SIGN /JNKLER/ 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 I www.everettwa.gov/permits
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<br /> B1w " a k In 0 ►i, P $ r f �� V,,,.?RO EGT, SITE INFORM TION ..
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<br /> PROJECT SITE ADDRESS: I?ba( eb(3 J P L PROPERTY TAX#:
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description)
<br /> tet» E * C TAC.r.„, IN�POR >' TIONrr_.. .: iryM� a ` '',.>t
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<br /> OWNER NAME: TENANT NAME(If Commercial):SI Ig- '' , b. 1s f
<br /> OWNER MAILING ADDRESS: STREET I%6C1 100-1. ' et.... St 'n 1 t� �{}
<br /> (,, �1 CITY Eu tui STATE I V ZIP I 6 b
<br /> OWNER PHONE: Z t\'.2--C • 551 • 30L22 OWNER EMAIL:
<br /> CONTRACTOR NAME: PQ i1. ( 1'c `- l v. ayv'7 -1 got(t-( lOtr1S
<br /> CONTRACTOR ADDRESS: `1 STREET PO 1✓ r 118
<br /> CITY IA(�, S )aLc STATE +_ ZIP 82
<br /> 9-0
<br /> CONTRACTOR PHONE: 3(.QD•Legg'41 CONTRACTOR EMAIL: l Yl f ( 1Qa IlV\Y be Q' c C OW)
<br /> COCONTRACTOR LICENSE#(REQUIRED): P I e-A-61 0a2 P CITY OF EVERETT BUSINESS LICENSE#(REQUIRED) 5305&
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<br /> PRIMARY CONTACT: 0 OWNER E;2(CONTRACTOR 0 OTHER(Please Specify)
<br /> CONTACT NAME: CONTACT PHONE: 51.p0.Le: 8- 1660
<br /> 3e.IAAV',Jl. 6 1 \(t(,L-C\ CONTACT EMAIL: i (\C>eu ” vy\ + A .� v N_.
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<br /> ,. t„r� :` ” .� BUILDFNGPERMIT APPLICATION Y,. , • . ..' 1' .,. ....
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<br /> Existing Use of Building: Contract Price of Work:$ C.3Db
<br /> Proposed Use of Building: Heat Source: El Gas )Electric ❑Other
<br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: J Commercial ❑Industrial
<br /> Type of Project: ❑New ❑Addition ❑Remodel gRepair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> CCA Q ct :Ch&L.e_e, (Ak.Q. a:.12
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MEC AMICAL7PEIT APP;LICATl4N , , r . .. UMBING PERMIT APPLICCAION - „ „
<br /> Type of Project: New _MRM
<br /> Addn Alteration _Repair Type of Project: _New Addn _Alteration _Repair
<br /> List of Fixtures #of List of Fixtures
<br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures Fixtures
<br /> 1 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 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 /> 4 i`» 'SPP II 410:4 SUPPRESSIw0 SYSTEM .S fes:
<br /> Chemical or Water 1 INo.of Heads
<br /> ACKNOWLEDGEMENT.:1 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 /> U i
<br /> PEFfly #k " 2....,
<br /> Ow er/Authorized Agent Signature Date (Revised 9/23/2016)
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