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Jun 12 2018 12:56PM Washington WatemHzaters 8663757454 page 1 <br /> 4677PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING!SIGN!SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> CP)425-257-H10 i FAX 425-257-8657 1(E)everettepsOovsrettwa.gov 1 wwwt,everellwa.uov/perniits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: tdJ (S'/ $ PROPERTY TAX#:0670nde lo " <br /> LEGAL for new construction: Short PlaVsubd:vision!._, <br /> Lot No. — copy long legal of <br /> description) <br /> CONTACT INFORMATION <br /> OWNER NAME: Al I rn en f') bob TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: &TREE- 'Z2 11 St 36 4- <br /> CITY p ` STATE we DF ./2 <br /> OWNER PHONE: 7-0144710 i_ p Jt/3 DOWNER EMAIL: ...- <br /> CONTRACTOR NAME: W*$ i A orrbN W ply12.. N[,A - 5 • <br /> - <br /> CONTRACTOR ADDRESS: STREET 11p,1�5(2._r,�/�C r(e hit( � -- PO BOXY( Gt 1J a��)191)5S'ifs'', y <br /> CITY pC Lam! V O ( STATE [d A ' F 1 L15O <br /> CONTRACTOR PHONE: 426 4g3- L/'7/ jCONTRACTOR EMAIL: (hi(f/ -HV/JC C.Z 6014611L, atm <br /> CONTRACTOR LICENSE#(REQUIRED): WJQ'- 4- AO CITY OF EVERETT BUSINESS LICENSE#(REQUIREED): ' 3 VC' <br /> PRIMARYTTCONTACT: 0 OWNER i ,CONTRACTOR 0 OTHER(Please Specify) <br /> C N7'ACT�t ME����� CONTACT PHONE: (�2��-,��3_[/�7! ' <br /> c_,I) I s CONTACT EMAIL: tt)ll Trtl/ 4-(_.@ 6r"�L,(7j ') <br /> t �UiLbING PERMIT APPLICATION <br /> Existing Use of Building: I Contract Price of Work:$ d _ <br /> Proposed Use of Building: Heal Source: OGas N <br /> At ric OOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex jj i-Family.#of Units:, i ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair QT.l. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> C,14.4 0 r-e. '4' 64 (A) 6t/ A (L <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 #of #of #of <br /> Fixtures Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures <br /> A/C-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 /> - <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kl:chen 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 /> • SPRINKLER/SUPPRESSION SYSTEM <br /> Number 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,stale,and local law. 7ha granting of permit only author es approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.1 am owner ori am auftonzed by the owner of this property to perform the work for which application Is made, <br /> and I comply with the State Contractors Law 18.27 RCW and 200,200 AC. <br /> City of Everett O(Fcia/Use Only <br /> L-V/ 6 --0-4- 1.71H0 0M <br /> ISbCe, <br /> Oorized <br /> Agent Signature Date <br /> (Revised 5/20/2010 <br />