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PEI- IT f/1PPUICATION <br /> 'UILDINO I MECHANIC F..L/ PLUMBING I SIGN I SPRINKLER I [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)ev- - ep !.)everettwa.gov www.everettwa.gov/permits <br /> '(I'he or clack hik Only Please) pr.07:0171 PtCy Milt-ION <br /> PROJECT SITE ADDRESS: 17 - 81)/i-14 <br /> - fi ✓ PROPERTY TAX#: 1/i ��5 U <br /> LEGAL for new construction: Short Plat/subdivision of N. (attach copy of long legal description) <br /> Its TACT INFO•MATIoN <br /> s__. <br /> OWNER NAME: rat4A,60 TENANT NAME(If C mmercial): <br /> OWNER MAILING ADDRESS: STREET 7 „-- sr(--.... <br /> CITY e//� 1/40 STATEWie- <br /> zrP�// <br /> OWNER PHONE: �/V JC/ OWNER EMAIL: <br /> • <br /> CONTRACTOR NAME: x;,;';:00 ) 51" /-€(� (C ifre c G <br /> CONTRACTOR ADDRESS: STREET 416. 0 5 (1 67 74-11. 5,/ 5,E, <br /> cry ad / h, / STATE ZIP 62 ('�� <br /> CONTRACTOR PHONE: 2'06' �f(e) - a-7 r CONTRACTOR EMAIL:9(-(�L' i iMliC'( ' ,VVVcon <br /> /6, !/ 1- <br /> CONTRACTOR LICENSE#(REQUIRED): (J(f '3 / 6,6,,,,-13 co / CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR j2c.C2THER(Please Specify) „Arch(it <br /> CONTACT NAk--(A/1-k\ <br /> E: �--�^ q�� �'j,, CONTACT PHONE:/I� 0,x/6 "7(5 i• 1 <br /> k--(''v 11' ' v v o 7 \ CONTACT EMAIL: (i`.a�d's'C C 5I li I .' 1 V <br /> BUILDING PERMIT APPLICATION . Af <br /> Existing Use of Building: )5 < Contract Price of Work:$,_14 — (jU[I�� <br /> Proposed Use of Building: //:4 (/�C4,� ('1,� Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: • ❑Commercial dustrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair „tel. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: /4 '/ // t-1,1. -. ew h., epset /...".0i/k-iii c'iej/I e'y4 <br /> CMC ctn ?cod{ Cpy1 / c1.5 -la Kee awe' £fit,5/4// l rz` eq5 <br /> km mg <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration Repair <br /> #of List of Fixtures #°f List of Fixtures #of List of Fixtures #°f 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 /> r 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 RangeC9' 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 I SUPPRESSION SYSTEM <br /> Chemical or Water f No. 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 I co ply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> Allik ► PERMIT# <br /> Ir 7i df ._. '111 ? ...O . . <br /> �" <br /> Owner/A thorized Agent Si ature Da � (Revised 9/23/2016) <br /> I( <br /> 1v <br />