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May 01 2019 01:32PM Washington Wateaters 8663757454 pages <br /> PERMIT APPLICATION <br /> ,e9*. BUILDING I MECHANICAL! PLUMBING/SIGN 1 SPRINKLER/DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> '"J 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8557 I(E)everetteps©everetlwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT iTE INFORMATION • hh �7 <br /> PROJECT SITE ADDRESS 15a GE k. PROPERTY TAX#:bO�� otb1 100 <br /> LEGAL for new construction: Short Platisubdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:0\anal TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET al r' a_ <br /> CITY ee e- STATECAA ZIP elba <br /> OWNER PHONE:L 5--75O--a7 1 1 OWNER EMAIL: off <br /> CONTRACTOR NAME: W l tt iato.i Wit}' - H ��`-" PO �Dx ,� �U <br /> CONTRACTOR ADDRESS: STREET 1115 22_., 1 t C, 4-rt 'S6f�yq C��jy� y <br /> Cm R t7 it r STATE i/" .1 ZIP / Q U 5O <br /> CONTRACTOR PHONE: li26 rlg j3_ `1g7/ CONTRACTOR EMAIL: WirHW -HVAC 4/146 ILd C(1/'J <br /> CONTRACTOR LICENSE#(REQUIRED): A.J* ,7 4--quo- ^"-+ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3 `- <br /> PRiMARY CONTACT: 0 OWNER .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME,,' CONTACT PHONE: q2.. - 'g3-c/s 7/ / <br /> r Do 'ii-e Is CONTACT EMAiL: W/jFj,(/f-11/../`� _ 6Mt/L.O m <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ " 1. — . , . <br /> Proposed Use of Building: Heat Source: EiGas I` :chic DOther <br /> Building Type: 3FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel DRepair ❑T.I. ❑Si9n ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPT ON OF WORK: / <br /> 1 01/1ht (4--eP/ACI— 1 E-lec/—ot <br /> 616/7(s) <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 _Rep rr Y/c <br /> #of #of tt of #of �`f`L`--�" <br /> List of Fixtures List of Fixtures List of Fixtures Lisa of Fixture <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 /> 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 f Water Heater Other: <br /> Exhaust Fan Sink(ServicelBar/Mopletc.) Other: <br /> • SPRINKLER I 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,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,1- , he owns,or am authorized by the owner of this property to perform the work for with application Is made, <br /> a , :„•Ly with the State Contractors Law 18.27 ROW and 255.2-I. WAC. <br /> 0 <br /> / Cw0 <br /> City of Everett Official lice Only <br /> PE <br /> 1 ,�' n�oS O 25 <br /> Owner/Authorized Agent Signature Date (Revised 5/20/2016) <br />