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• <br /> :..° °�< PERMIT APPLICATION <br /> • <br /> j�,. 7}� � BUILDING/ MECHANICAL/ PLUMBING I SIGN /SPRINKLER/DEMOLITION <br /> 's >t 'f CITY OF EVERETT PERMIT SERVICES <br /> iJ " rs 'r 3200 CEDAR STREET,EVERETT,WA 98201 <br /> 7 qm kit MY)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> �(Eirdrge.©1 B6ai�n3 Ilvak AfnlyPlease) PROJECT SITE Ilk FORMATION <br /> [i� Z61 PROPERTY TAX#:ZSO IZOOODZ Boo <br /> 'PROJECT SITE ADDRESS:,8313 � ,�u'� (.C9�57 <br /> Ir <br /> 17_.t+.�:+ln.for new construction: Short Plat/subdivision Lot No. I� ct(attach copy of long legal description) / <br /> -,z -- tea_ <br /> CONTACT INFORMATION ION <br /> IIL 6jt l?.o NAME: Alt/fie/ iUGtf` * TENANT NAME(If Commercial): <br /> WsINER MAILING ADDRESS: STREET /2.Ds- /3 o 74-1 , . Se. 40. A <br /> 1) CITY —7 C. / / STATE U 41r ZIP 'O <br /> Ace <br /> Li <br /> 'IOW zER PHONE: 4-23*----5V/ - ‘• -. '/ OWNER EMAIL: <br /> I}CONTRAC T OR NAME: 5e '/%Gam/ A467./ ` !l f®Y9iT ,o774/7fist/ GG C <br /> ,iCON'F RAC a OR ADDRESS: STREET [ 2.e ! , o 17 c r- s'e de 4- <br /> p� <br /> CITY vv �� ��_ STATE (/// ZIP?V 20 4-7 <br /> 'ICON T RACTOR PHONE: 1/ f l-5V2 / -6 9/ CONTRACTOR EMAIL: 5 DA-FMCS 6 CT/rl A.r C <br /> `ICON TRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> F o-3.EIARY CONTACT: 14 OWNER IE CONTRACTOR AOTHER(Please Specify) d ro lJ iffido D 6 <br /> Iifi + CONTACT PHONE: -. 93 <br /> IL:t�4N'I'A�T NAME: �6 s -2�-/ 2 <br /> '/fMf1! vG CONTACT EMAIL: ifC, ' Cif /foray , cAon <br /> N BUILDING PERMIT APPLICATION <br /> 'Existing Use of Building: Contract Price of Work:$ <br /> Ci <br /> 11Proposed Use of Building: t2 2._ ,&cA‘W-7 M G T$' Heat Source: OGas ❑Electric ❑Other <br /> f <br /> ijBuilding Type: ❑SFR-Detached ❑SFR-Attached ODuplex Multi-Family-#of Units: I J ❑Commercial ❑Industrial <br /> '!Type of Project: gNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> CDE., <br /> iILIESCRIPTI N OF WORK: - <br /> j"s. �o14,5•7 7v'A/ c, S S7- - <br /> [I a w 1J &,Nepv S /4,-r +-- fr-4124 ---,, <br /> 11ASSOCIATED BUILDING PERMIT#(if applicable): CJ <br /> e <br /> I._s <br /> ilE:C 1A.�ICAL PERMIT APPLICATION:. PLUMBING PERMIT APPLICATION <br /> 'Type of Project: >4.New _ Addn Alteration _Repair Type of Project: New _Addn _Alteration _Repair <br /> ti #°i List of Fixtures #°f List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> ''•Fixtures Fixtures Fixtures Fixtures <br /> ik.�.- <br /> 0_ - . 1 A/C-Air Handling Units Heat Pump - 5 Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> LGas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> N ( Water Heater Refrigeration - Shower Floor Drain <br /> ?? <br /> -11 ,, !Gas Fireplace - Wood Stove Kitchen Sink&Disposal Grease Trap <br /> y� --;Gas Range Ducting _ Li Dishwasher Roof Drains <br /> n ( IIClothes Dryer Hookups Other: f Clothes Washer Medical Gas <br /> v __ ;,Range Hood _ Water Heater Other: <br /> n Exhaust Fan — !Sink(Service/Bar/Mop/etc.) Other: <br /> j <br /> +i_ speag[l` [rELER.'/SUPPRESSION SYSTEM. <br /> j' _________J 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 /> currant 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 I 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 /> ( /f ' I PERMIT# n/ l/1 0 0 O <br /> O�rner/Authorized Agent Signature Da e (Revised 9/23/2016) <br /> 1/2 <br />