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PERMIT APPLICATION <br /> k BUILDING/MECHANICAL/ PLUMBING I SIGN /SPRINKLER/ DEMOLITION <br /> h5 <br /> r CITY OF EVERETT PERMIT SERVICES <br /> 90 n' 3200 CEDAR STREET, EVERETT,WA 98201 <br /> �Aik . AI,my)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> E3Lrlte,om Motet Oink Only Please) PROJECT SITE IIr F,•RMATION <br /> IIPROJECT SITE ADDRESS:,t)32/ z14 4'. (..(9.$7 PROPERTY TAX#:2$d$I Z 'O f%'Z�/160 <br /> I+L.E.v3��L.for new construction: Short Plat/subdivision Lot No. q (attach copy of long legal description) 6l / <br /> i CONTACT INFORMAT1ON' <br /> I U�W�I,ER NAME: he-mei t�U(..fi�,f- TENANT NAME(If Commercial): <br /> , 2.OWNER MAILING ADDRESS: STREET � D$ /3 o ll f. Se' A <br /> II CITY ---7/e--. C---7 7 STATE 1,4) — ZIP /cc'2 0 <br /> 'Oti'rNER PHONE: 42 5-D/- ‘• - ,•./ OWNER EMAIL: <br /> r. <br /> CONTRACTOR NAME: 5e4.--5 C9 0,9v-c-'-te',Yew Fogg//DA/ GGC <br /> CONTRACTOR ADDRESS: STREET (24f / o a £r se de ,if- <br /> -. <br /> 1 <br /> 1 CITYCyr.---/— STATE (/t/ ZIP 9V 2.0ce <br /> I;;COONTRACTOR PHONE: ��f%-57 — cc,/ CONTRACTOR EMAIL: 5 D c f t ICS�G/f't r G r C 1 <br /> ,,CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> !':ithillARY CONTACT: 51 OWNER ®.CONTRACTOR ,MOTHER(Please Specify) 0 oN 'f u/o d 6 <br /> tr_.. r CONTACT PHONE: — 93 <br /> �;:,t�;�N T,�,.CT NAME: �b S -2-7--i 2 <br /> khz-H . /, -t if-- CONTACT EMAIL: if-C, A C ff�i 1Y L. c- rt <br /> BUILDING:PERMIT APPLICATIONS <br /> Existing Use of Building: — Contract Price of Work:$ <br /> Proposed Use of Building: 2- , - tr -7 M t GTS Heat Source: I2Mas ['Electric ['Other <br /> i(Building Type: ❑SFR-Detached ❑SFR-Attached ['Duplex 18Multi-Family-#of Units: I S ❑Commercial ❑Industrial <br /> hype of Project: gNew DAddition ['Remodel DRepair DTI ['Sign ['Sprinkler ['Demolition ['Change of Use <br /> _., <br /> hDESCRIPT:ON OF WORK: <br /> j Coi 1- 1 7v 4t.>A/ e, 5 cam,- <br /> 1 a1 w/�i 640 f- t / 7b�-c k` <br /> 'tE4t-i�Xft' / <br /> t, , <br /> wAaSOCIATED BUILDING PERMIT#(if applicable): t <br /> F P y cl=AA;,ICAL PERMIT APPLICATION; PLUMBING PERMIT APPLICATION <br /> `!Type of Project: V— <br /> New _ Addn _Alteration _Repair Type of Project: New _Addn _Alteration Repair <br /> 's_._ <br /> of Et #of #of #of <br /> List of Fixtures List of Fixtures list of Fixtures List of Fixtures <br /> itit Fixtu;c-s ` Fixtures Fixtures Fixtures <br /> 1) - A/C—Air Handling Units Heat Pump - 5 jToilet Backflow Preventer(Inside Bldg) <br /> j Forced Air Systems . 4 Unit Heater �_Bathtub Urinal <br /> hII� _Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> ( Water Heater Refrigeration Shower Floor Drain <br /> _ <br /> Gas Fireplace — Wood Stove 'Kitchen Sink&Disposal Grease Trap <br /> "1— ;Gas Range Ducting — Li Dishwasher Roof Drains <br /> cClothes Dryer Hookups Other: f Clothes Washer Medical Gas <br /> II_ 1 xRange Hood _ Water Heater Other: <br /> it exhaust Fan ---- Sink(Service/Bar/Mop/etc.) Other: <br /> j; STG E W:LER/SUPPRESSION SYSTEM <br /> i; Number of Heads <br /> I <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.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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> • I PERMIT# <br /> ( 7/ G 11 D C-o (k2 <br /> -awned/Authorized Agent Signature Da (Revised 9/23/2016) <br />