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Apr 24 2018 01:44PM Washington Wa=--Ieaters 8663757454 pase <br /> • <br /> grrPERMIT APPLICATION <br /> BUILDING /MECHANICAL 1 PLUMBING 1 SIGN / SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT, NA 98201 <br /> 03)425.257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /LPf S 'lett- Si-- ,5g PROPERTY TAX#:(6 3 )'/ Ob60130"/ <br /> LEGAL far new construction: Short Plat/subdivision .., Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Pf 4.IcJ &A/Nit/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: sTREer /c uj .-9-$ �{/f(� /,J}J��y _ <br /> cm J� STATE r/ 7 1 f V k3 <br /> OWNER PHONE' 1 OWNER EMAIL: <br /> CONTRACTOR NAME: tift0I 1t.161f-i +E(,! 1t- f � T66 yr �r) <br /> CONTRACTOR ADDRESS: STREET I1,I���JZ.�,/�C i i, 4 V L. 56 — PG �OX v 92" g Q y <br /> CITY 1_.. Ld7 V♦ t STATE ii /� ZIP l sO <br /> CONTRACTOR PHONE: 42.6-g.g3- gg77r O! CONTRACTOR EMAIL: ,I/'}-tai1Vf}C C" 6i/14/4,Li Cern <br /> CONTRACTOR LICENSE#(REQUIRED): iv)4 y t - q3 f! CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 06 W <br /> ll <br /> PRIMARY CONTACT: 0 OWNER I .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME' CONTACT PHONE: �2 - '3 <br /> —r/ <br /> 7/ <br /> V' cf Valli-as CONTACT EMAIL: 146JR-Hi, "i`C@ V �jL.um <br /> Q tt h BUILDING PERMIT APPLICATION <br /> Existing Use of Building: ��- L <br /> �b ��/�' Contract Price of Work:$ l <br /> Proposed Use of3 Ming: Heat Source; ❑Gas DElectric ❑Other <br /> Building Type: R-Detached OSFR-Attached ❑Duplex <br /> CI <br /> Building Units OCommercial I]lndu a <br /> Type of P-oject: New ❑Addition ❑Remodel DRepair 1:1T.1. DSign ❑Sprinkler IJDemolition ❑Change of Use pi1ii /''t1 <br /> DESCRIPTION OF WORK: ., <br /> ki14011. —•/ 40/CU / 9a,a_ N a.-i'A /r--, _.. <br /> ASSOCIATED BUILDING PERMIT#{if applicable); <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New T Addn Alteration _.-.Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AIC—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 Raige Ducting Dishwasher _ Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range food (Water Heater Other: <br /> Exhaus.Fan (Sink(Service/BariMop/etc.) Other. <br /> I _ - <br /> • SPRINIIfk.ER 1 SUPPRESSION SYSTEM <br /> INumber 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 roust 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,lam the owner,or 1 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 Lew 18.27 RCW d 29E.200A WAG. <br /> City of Everett Official Use Only <br /> ( PERMIT# . <br /> Cel L_177' mi0Li� o i <br /> ?fait/ <br /> uthorized 4gant Signature Dale (Revised 5/20/2.015) <br />