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PERMIT APPLICATION <br /> /"--_--) <br /> '\� BUILDING /I1t1ECHANICAL/PLUMBING/SIGN/SPRINKLER/DEMOLITION <br /> ...4 CITY OF EVERETT PERMIT SERVICES <br /> /",z/` F„.4,;77/ 3200 CEDAR STREET,EVERETT,WA 98201 <br /> i <br /> (P)42.5-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> ;a _:.__ . PROJCO*JTE INF®RMAT]ION 1 <br /> PRO�I,dV✓T AD Hi r �.� PROPERTY TAX#: <br /> Do yS3y0Zpolob <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C®�TAid- 'i�IPOIkkIiiAinto.' ::=._ <br /> OWNER NAME: Vigirmapa /..4, a t)si VY NAME(If Commercial): <br /> 'OWNER - G ADDRESS: STREET (A O .fix o6 8 <br /> i <br /> \ crrY j,,Va htAk0 STATE W IV ZIP/ /g03b <br /> I OWNER PHONE: , a - *45 ;f• OWNER EMAIL: 1 Ipn 6 4.r G C,' , 4* . . <br /> • ....I <br /> !CONTRACTOR NA 'Of-�,��_� - - .. k � ��kc k (\ b <br /> CONTRACTOR ADDRESS: TREET 43.04 1J4!a (] Q <br /> CITY ^d off, STATE l v fret 9 g2 /a <br /> • <br /> ICONTRACTOR PHONE: .�" CONTRACTOR EMAIL: ' -let--••+ • <br /> LICENSE*(REQUIRED): <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS' .... _..__,..__._..._._._w_:__._.___.,. ....._._ <br /> PRIMARY CONTACT: b OWNER SI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: �J 5..399J f 3 19 <br /> L • 0 Y� I_ CONTACT EMAIL: 11," • , - � , <br /> IBI,IDLDIG�'G PERMIT APPL1CAT9�:� <br /> Existing Use of Building: /fl u t e f' ,41-01/4/ Contract Price of Work:$ 6000 <br /> Proposed Use of Building: Heat Source: ISlGas ❑Electric El Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex NfVlulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project El New ©Addition QRemodel ❑Repair DT.l. USign ❑Sprinkler ❑Demolition ❑Change of U�Se <br /> DESCRIPTION OF WORK: MOV G WR11 b.. 1n2�# t Neu? W 1✓ cky..)5 'gR\eo t <br /> I G <br /> ASSOCIATED BUILDING PERMIT#(if applicable): — <br /> f <br /> MECHANICAL PER11111Ti4o'Pi!1 ,TION ... _.:_; PLUM 1NG.PERMIT APPLICATIOitI . <br /> Type of Project: _New_ Addn _Alteratipn Repair Type of Project: _New Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixture # f List of Fixtures #°f List of Fixture <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units _ Heat P -• Toilet Backflow Prey (Inside Bldg) <br /> Forced Air Systems U.' eater Bathtub Urinal <br /> Gas Piping :oiler Lavatory(Wash Basin) ' Ing Fountain <br /> Water Heater IV' 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 Wash- Medical Gas <br /> Range Hood Water H- -r Other: <br /> Exhaust F. ' Sin :ervice/Bar/Mop/etc.) Other: <br /> umber of Heads _ \ i <br /> current federal,state,and local law.The grantingof apermit onlyauthorizes approved <br /> 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 /> v✓ork and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Build g Official before being authorized under any circumstance.lam the owner,or tam authorized by the owner of this property to perform the work for which application is made, <br /> and comply with the St- - : -.. -. 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> _ <br /> .� L.3, Lcosr_Oso5 <br /> 0 er/Authorized Agent Signature Date (Revised 10/12/2015) <br />