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P <br /> PERMIT APPLICATION' <br /> BUILDING!MECHANICAL/PLUMBING I SIGN C SPRINKLER I DEMOLITION <br /> voliavi CITY OF EVER i i PERMIT SERVICES <br /> 3200 CEDAR STREET,EVE,RETT,WA 98201 <br /> (P)425-257-8810 1 FAX425-257-8857 1(E)everetteps@everettwa.gov i y w,vevereftwa.govlpermits <br /> (Ohio or llleckO <br /> hiI ' ry.l}lease) PRQJECT Sil..Th liilFO,tMATION ' <br /> PROJECT SITE ADDRESS 1/7 -- -6PROPERTY TAX N. <br /> T <br /> LEGAL for new construction: Short Platlsubdlvision Lot No. (attach copy along legal description) <br /> . CONTACT IMFORMAT1ON: <br /> OWNER NAME: /gC + le } TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET -7��I ? - 33A 5 <br /> 01TY t r.i,,�(y STATE zip <br /> OWNER OPHONE ..;` ) .t 3':"-41,-.2 OWNER EMAIL i ".. <br /> CONTRACTOR NAME: E U .G 7`s -t`tf - E T r -c- <br /> Ct3NrRAGTOR ADDRESS: STREET '2-1 SO <br /> r� PA 1 fit) py <br /> g1TY '�✓UEWASI`IpSTATE (A/A— zIPS10°0 ' <br /> CONTRACTOR.PHONE: 2-5...2.5 2„,t6 1114 • !CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE AREQUIRED) CU 3s to,21.r?'I' Ici f OF EVERETT EUSINESS LIGE fSE O(REQUIRED) is fa <br /> x%.....-:..:...+-.-.f..r-..xw..w.YwR.....�a..»...w..eeww....-r.n..:•.... .u...w'.v.-.4.�.r ...+.-.,........on« .»-.*..-_...,L«:.::n...>•t...�w.0 a.-ts..««-.. ..+.. 'e.....'.y�,.....w....r—.r........rwk+a�wr-.. •+Y:..>a. .. .r«-.- <br /> PRIMARY CONTACT: 0 OWNER RCONTRACTOR IJ OTHER(Please Specify) 4 <br /> CONTACT NAME: <br /> CONTACT PHONE: 7 s 25-2-`)d/ <br /> 5CONTACT EMAIL: I.d3G Afar- . <br /> • 130IIDING'P'RIVI'ITAPP;LIcATION • - <br /> Existing Use of Building: 1 <br /> Contract Price of Work:$__� , <br /> Proposed Use of Building: Heat Source; Cas QEtecfric C(Other <br /> Building Type: SFR Detached CISFR-Attached ODuplex Multi-Family e4 of Units: QCommercial Cllndustrial <br /> Type of Project; ❑New OAddition aRemodei ❑Repair DSign QSprinkier DDemolition ©Change of Use <br /> DESCRIPTION OF WORK.14.441(—re <br /> ` .. / - . I a+%G ' . <br /> %C,;1 7-0,- tic Y7—.. --161-:7-- <br /> ASSOCIATED BUILDING PERMIT#if a licable.; <br /> .1 ' ;hVI) C ,1,ANLCAL.,I�ERMT'I .APPLICATION ? PLUMWWNO P RMIT APPLICATION • <br /> Type of Project:New Addn Alteration Repair Type of Project law _ Addn Alteration Repair <br /> ' #of #of #of #of <br /> List of Fixtures List ofFixtures List of Fixtures List ofFixttires <br /> Fixtures Fixtures textures Fixtures <br /> NO-.Air Handling Units - Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> t Forded Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fire lace 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 /> ' PI.!E!993 L1 1i 1 ,0f:Pill O; Ird SY§TEYVi.. . <br /> Number of Heads <br /> ACKNOWLEDGEMENT.'I haVe reviewed'this application end confirm the information conterbed hererii is tea end cared Work done parsuahtfo this permitmusf Comply with <br /> current federal,state,and ccailaw.The granting of a permiton yauthorizes approved work and no deviations therefrom.Deviations must first he authorized In writing from the <br /> Building On Ofileial before being authorized under any clleumstanca lam the owuai or i am.euthorrzed by the owner of this property to periurm the work for which application Is made, <br /> and/comply wit/i the Stale ConfractorsLs 7RCWand:290.200AWAC. <br /> City of Everett Official Use Only <br /> T.14.,\...., , 4/4 <br /> OwneriAuth rized Agent Signature Date (Revised 5/2012016) <br />