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PERMITgn"
<br /> IIIAPPLICATIONS
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN /SPRINKLER/DEIT
<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 www.everettwa.gov/permits
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<br /> PROJECT SITE ADDRESS: ,j( 1/S(�.�V) p j& PROPERTY TAX#:/]/)/ j/�( JY JV,IiJ v
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. W (attach copy of`long legal description)
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<br /> OWNER NAME: \4Q �/� n TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET i 1,0 1 V ,
<br /> CITY EV f, STATE' Jk ZIP Ct/'WA
<br /> OWNER PHONE:101j45..-110 OWNER EMAIL: Ral 1(VVV�__ /� �"'iiiJJJ1 r -Co
<br /> CONTRACTOR NAME: 13 "!( y1 �Jlyy�
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<br /> CONTRACTOR ADDRESS: STREET 1 g At
<br /> `^eft,, //� �W I
<br /> CITY / lv,'fA 11 e/ y��., STATE ,- ZIP ele S
<br /> CONTRACTOR PHONE: - r ` 11MY^WY"� CONTRACTOR EMAIL: - Sera 0 ? LI' I . / Iii vii _ I,
<br /> CONTRACTOR LICENSE#(REQUIRED): `�'j F(`-1 E \ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):05210 0
<br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify)
<br /> CONT CT NAME: CONTACT PHONE: LT,
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<br /> \nnoh kc Q CONTACT MAIL: . to vrn\nr .l OY f l
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<br /> , �� ��I ,., �APAP, �,.� N � ,I� _ ,�_
<br /> Existing Use of Building: Contract Price of Work:$ t G.}n
<br /> Proposed Use of Building: Heat Source: ❑Gas lectric El Other
<br /> Building Type: latFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial
<br /> Type of Project: 'lew ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
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<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> MECHANICAL=kPERMIT APPLICATION r „:r, 4 ' PLUMBING=,#ERMOti*t'PLIOAtf ON A424, 4
<br /> Type of Project:XNew 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 /> A/C—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 I
<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 /> SPRINKLER F SUPPRESSI.O_NI 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.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'comply with the St to Co-tractors Law 18.27 RCW and 296.200A WAC.
<br /> / City of Everett OfficialiaUse Only
<br /> allPERMIZ ` _ I V©14
<br /> Own- /A k orized i n• ure / ate (Revised�11100/112/2015
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