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0 • <br /> PERMIT APPLICATION <br /> ' F� .. 01. BUILDING/MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> �` CITY OF EVERETT PERMIT SERVICES <br /> �, ,,.L' r tr r4. 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ; <br /> , r ���As a )425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (BRvie©rt:311ack kik .!nlyPlease) PROJECT SITE INFORMATION • <br /> lIPROJECT SITE ADDRESS:, �.0 j- ��� . � .� PROPERTY TAX#:2ppC)4I2OO Z 700 <br /> 1,1.EG +'' L for new construction: Short Plat/subdivision Lot No. 3 (attach copy of long legal description) at ®",L <br /> l._,z��.... .. CONTACT INFORMATION <br /> iI OWi ER NAME: l',X4 / i liiLi - er- TENANT NAME(If Commercial): <br /> tkOVINER MAILING ADDRESS: STREET /2.O,s /3 0 11 .Cr, Se• A <br /> ice_.__.. 1 ,W/ Q <br /> l; CITY j'V [7-7 / STATE ZIP ?oD. Dee <br /> II le'illkiNER PHONE: 4 2r V/ 6- ,.lf'` OWNER EMAIL: <br /> IICONTRACT OR NAME: 5 e4=77-C.9 4t'�t/t fdY9NT „frog477 e/ GL.0 <br /> O <br /> ili' <br /> CONTRACTOR ADDRESS: STREET ( ,( /50 17 der" -C6 de 4— <br /> CITY C t f 7 STATE t/ti ZIP 9<('liV <br /> liCON€TRACTOR PHONE: 2 f%-5/ -6 / CONTRACTOR EMAIL: 5DA-ftMCS 6Q/1rf i L r M <br /> 4{CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> ,i T.htiARY CONTACT: a OWNER ®-CONTRACTOR , .OTHER(Please Specify) d D/J of ceo D 6 <br /> r_ CONTACT PHONE: -- 95S" -2�-i 2 <br /> �I;��I���-�.�T NAME: 2d b <br /> I e/-Ie -L./G B CONTACT EMAIL: /f'C• A C`e- (c`J %iY . Go /Y <br /> fi s BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> I <br /> Proposed Use of Building: ‘2.2- 7 M T5 Heat Source: IfGas 0 Electric CI Other <br /> [ uiiding Type: ❑SFR-Detached ❑SFR-Attached ODuplex gMulti-Family-#of Units: 1 3 ❑Commercial ❑Industrial <br /> !!Type of Project: g.New ❑Addition ❑Remodel El Repair DTI. ❑Sign ❑Sprinkler 0 Demolition ❑Change of Use <br /> qt <br /> hi..)ESCRIPTION OF WORK: <br /> l Cot4'7 72:: 'Ar o 5 e-- <br /> ,i V't-1 w 1J f to +, 2�r&-r7 6 f %/--�'- �� <br /> \ j <br /> IIASSOCIATED BUILDING PERMIT#(if applicable): "'i <br /> r MEMO—MICAS. PERMIT APPLICATION,: PLUMBING PERMIT APPLICATION <br /> )Type of Project: A New _ Addn _Alteration _Repair Type of Project: V-New _Addn _Alteration _Repair <br /> u~#,,, <br /> +i ,., y rf I List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> ra.u,cs Fixtures Fixtures Fixtures <br /> fi_ - _ (AiC-Air Handling Units Heat Pump - 3 iToilet Backflow Preventer(Inside Bldg) <br /> lw Forced Air Systems 4 Unit Heater 2 Bathtub Urinal <br /> jl Gas Piping — Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> I,- Water Heater Refrigeration _ Shower Floor Drain <br /> — <br /> g -.4Gas Fireplace - Wood Stove _ Kitchen Sink&Disposal Grease Trap <br /> II� iGas Range Ducting _ l Dishwasher Roof Drains <br /> li Clothes Dryer Hookups Other: f-4 Clothes Washer Medical Gas <br /> _ 1 FRange Hood _ Water Heater Other: <br /> it CJ j Exhaust Fan ——1Sink(Service/Bar/Mop/etc.) Other: <br /> I <br /> 1_�TSPRRI:?KLER/SUPPRESSION SYSTEM <br /> [1 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 /> cur.+-ent 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 1 am authorized 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 296.200A WAC. <br /> City of Everett Official Use Only <br /> / t/// , PERMIT#�17d l ,d(el <br /> Agent Signature /Da e (Revised 9/23/2016) <br /> ( 111--- <br />