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Mar 22 2019 01,38PM Washington Wate —aters 8663757454 page 1 <br /> PERMIT APPLICATION <br /> BUILDING/MECHANICAL I PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> /11111PAIlbi CITY OF EVERETT PERMIT SERVICES <br /> ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 1(E)evereltepsaeverettwa.gov I www.everettwa.govlpermite <br /> (Blue or Black Ink Only Please)/ PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ID It..) L(2 r? P1 i'j7`t' /9 PROPERTY TAX#:oelveaeo00,5,100 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> Luba() CONTACT INFORMATION <br /> OWNER NAME: Luba() Michael TENANT NAME(If Commercial):OWNER MAILING ADDRESS: STREET Ib3� b0 f'`` P1 /J <br /> carr n2p STATE U'4 ,,, Boa <br /> OWNER PHONE: ao(0-2a7. gs..9V er L 3 OWNER EMAIL: --- <br /> CONTRACTOR NAME: WA-51-11 AJ6j17JN w eel-,mit &1.7 r fj <br /> CONTRACTOR ADDRESS: STREET I 1 Z it G lam- TSV( 5 -- /'o box ✓ 2. 6 <br /> CITY p eel f'Ui) STATE 1114 zip L d pr,,,U ssg. <br /> CONTRACTOR PHONE: 426^- 3- 0171 CONTRACTOR EMAIL: WA-UAW VAC 0 6th1 IL, (cm <br /> CONTRACTOR LICENSE#(REQUIRED): fitt'Wr ffire 1CITY OF EVERETT BUSINESS LICENSE*REQUIRED):EEQUIRED): OS 39'/' <br /> PRIMARY CONTACT: 0 OWNER 1ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME*` /� f CONTACT PHONE: 1l2-�✓'5K.3-Ca`7G/ / <br /> ✓ ! Dpi(-els CONTACT EMAIL: (,�{}-diti-ffL14@C�/ c+t�l f <br /> - <br /> BUILDINf PERMIT APPLICATION <br /> Existing Use of Building: A* el' 7 if Contract Price of Work:$ 130 a <br /> Proposed Use of Building: Heat Source: ❑Gas tirElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached F Quplex ❑Multi-Family-#of Units: ❑Commercial ❑Indust( <br /> Type of Project ❑New DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Us <br /> DESCRIP ON OF WORK: / y ,f <br /> 04 irt It''#610/Ael— <br /> (S) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION �-^f'� <br /> Type of Project: _New_ Addn _Alteration Repair Type of Project: New Addn _Alteration Reps <br /> #of it <br /> Fixtures List of Fixturesu!@s List of Fixtures #of List of Fixtures #°{ List of Flxtur <br /> FixtFixtures Fixtures <br /> NC–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 Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood 1 Water Heater Other. - <br /> Exhaust Fan Sink(Service/Bar/Mop/eta.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> (Number of Heads <br /> ACXNOWLEDGEMENT::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 o a•.'ring only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> a itding Official before being euthodzedd under en cir,urnstance,i am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> a comply wiln the slate Contract. c Law 152 Rr W and 295.200A WAC. <br /> } { iJ1 f / City of Everett Official Use Only <br /> I ' 0 3-.C7t "- PERMIT# <br /> MdalO , °ZS <br /> •wnerlAuthorized Agent Signature Date (Revised 5/20/2016) <br />