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PERI1 IT APPLICAT ON <br /> ,, • <br /> "" BUILDING/MECHANICAL I PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)»425 257-8810 t FAX 425257-8857 I(E)everetteps a@sverettwa.gov I yNw.everettwa.gov/permits <br /> Eiuue•d:Stack Ink Only (evise) ' ' PROJECT S8T INFORMA`irre <br /> PROJECT SITE ADDRESS: 1 VU.,r. / 3+12., 5.- ,, PROPERTY TAX*, <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> WP <br /> .c0TAT.INFO ATlON <br /> OWNER NAME: iffi [ 7„}(„ ; Os.& �(, IT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smear /� 1,*-4 4,61:4z t <br /> cm, iz STATE OA ZIP ~g <br /> OWNER PHON' ,41. .. ��a , �L,- A 1 OWNER EMAIL Ale <br /> CONTRACTOR NAME: re.U -7�L57`0,---01: "JC'Ec p;A-r_. <br /> CONTRACTOR ADDRESS: sTsser '2-f <br /> -- a4Gt AU d 2 <br /> CS? 0 6 STATE Gil -- ZIP- 1 C3I00/ <br /> CONTRACTOR PHONE: 4`L`J-2..e;2,'P5(i!4 ICONTRACTOR EMAiL: <br /> CONTRACTOR LICENSE#(REQUIRED)• C(1 4S X22.0 r crit OF EVERETT BUSINESS LICENSE#€(REQUIRED) C..)6-11.53- <br /> PRIMARY <br /> a6-11.PRIMARY CONTACT: ❑OWNER RCONTRACTOR EI OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: `f Z 5-X5'2- // <br /> e C.( CONTACT EMAIL: J tj <br /> BUILDING PERMIT APP.LIcATION: • • ,: <br /> l <br /> Contract Price of Work:$ / <br /> Existing Use of Building: l f or-v_, <br /> Proposed Use of Building: Heat Source: CIGes %Electric ❑Other <br /> Building Type: ❑SFR-Detached DSFR-Attached 0Duplex QMultl:Family4 of Units: 1t`Commerclal Ellndusfrial <br /> Type of Project: [New tJAdditlon DRemodel 0Repair I=1T.I, CiSign ©Sprinkler ClDemolition °Change of Use <br /> DESCRIPTION OF WORK: et4. LikNil---sp1,+. y�; ) ,_ tauu-r �t 141 <br /> / , <br /> t+ 6 yse- v ti !�}tc."i"` - 14,x�-, P,� i 6 (.1,,,0 tJA'� s-"+w b <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> •_ ' tvieCI AN(CAL.PERMIT APPLICATION I I • • . PLUMBING P itliti1t APPLICATION : • <br /> Type of Project: New Addn AlteratIon Repair Type of Project: New Adan Alferafion Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units r Heat Pump `toilet Backflow Preventer(inside Bldg) <br /> I 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 /> :'a11RIMitLEI L 0.10PRES4110.9 SSYPTEM <br /> Number of Heads <br /> -- <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,end 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,ort am authorized by the owner of this properly to perform the work forwhich application is made, <br /> and I comply with the State Contractors Law 18.2TROW and 296.200A WAG <br /> City of Everett Official Use Only <br /> PERMIT# <br /> Owner/Authorize Agent Signature Date (Revised 5f20/2016) <br />