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. <br /> 0157 ...r. PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING /SIGN /SPRINKLER 1 DE ,OLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT',WA 98201 1 <br /> (P)425-257-8510 ( FAX 425257-8857 I(E)everetteps©everettwa.gov I www.everettwa,gov/pr,,mits . <br /> (Blue or Black Ink Only Please PROJECT SITE INFORMATION <br /> _ }�y� �.,,.,��_r+__ ��f, � per- /, —�--��--- -,. -----.. <br /> PROJECTSITEAD Rt$S: g.Z au. t/fCCot. t�t�s'?(! r{PROPERTYTAX#:D0d7 /09.6,03 <br /> LEGAL for new constriction: Short Pt t/subdivision < w gib Lot No. (attach copy of long iegal description) <br /> CONTACT iNFORMATION <br /> OWNER NAME: UJ [( Ker � pp��7n!✓a�' "/ TENANT NAME(If Commercial}: - <br /> OWNED MAILING ADDRESS: STREET t/D {,.,.,3j `f�-(U1 i• Pr 3 D 1(� <br /> crry i STATE ! [ 'P F r a <br /> OWNER PHONE: 2 5 6 '^ 4:2-77 OWNER EMAIL: <br /> CONTRACTOR NAME: UJ/f5I t Ait-i t U!1/4.) t,u t r H <br /> CONTRACTOR ADDRESS: STREET /-11 7_, (Up <br /> (Uv`'`4- kir C - r 6 vQX 2D g �J <br /> • <br /> CRY "eY1J£/f I' STAY_ bur :P `... r 5(S. <br /> CONTRACTOR PHONE: 2-6—g-g3— � 71 CONTRACTOR EMAIL_ ta- 5m-L�'. b�,:: 6 ,'`6.eL ( m <br /> CONTRACTOR LICENSE#(REQUIRED): Witi- -1 -ga ' CITY OF svERe-rY•BUswEss LICENSE#(REQ'MED): 05, <br /> PRIMARY CONTACT: I1 OWNER C CONTRACTOR 0 OTHER(Please Specif)0 <br /> CONTACT NAME CONTACT PHONE; 2., , -C/ 7/ <br /> ii-c41 )6AI-cis CONTACT EMAiL: ti..4.54i/ht.?X.@ 6 � rC.-C1 "il <br /> 1 BUILDING PERMIT APPLICATION - <br /> Existing Use of Building: T , ter" I. { Contract Price of Work:$ IIIIIIIIIIIIII <br /> _...._:_- <br /> Proposed Use of Building: Heat Source: '0-s DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Du iex 11MUItI-Family-#of Units: ! ❑Commercial : Mindustri <br /> Type vi Piu t.r. ❑New ` <br /> yw j _ _ �/iJJiti�ii ❑RcicivJel ❑PxcNaii �IT.1, ❑rJ;y�, ❑Opri��letar ❑Dantiafitian ClChang- aiUs ! �t �( <br /> DESCRIPTION OF WORK: - <br /> of / .S boo /lu , ',/,,,,, <br /> ,,,) <br /> ASSOCIATED BUILDING PERMIT# If applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICA:ION <br /> Type of Project: _ New Addn Alteration Repei +'' >y Type of Project: _New _Addn _Altered.; _Repair:el <br /> it of #of ti of I ffofr <br /> List of Fixtures List of Fixtures List of Fixtures fst of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures . <br /> NC-Air Handling Units Heat Pump Toilet Backflow ". eventer(Inside Bldg) <br /> Forced Air Systems -_ Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Ffuntain <br /> j—j Water Heater Refrigeration ShowerFloor Drain <br /> Gas Fireplace, Wood Stove Kitchen Sink&Disposal Grease T-p <br /> Gas Range Ducting Dishwasher NM Roof Drain,. <br /> Clothes Dryer Hookups Other: ' 111111111 Clothes Washer MN Medical G-s <br /> Range Hood Water Heater Other ii <br /> Exhaust Fan Sink(Service/bar/Mopietc. Other: ' <br /> SPRINKLER/SUPPRESSION SYSTEM . <br /> Number of Heads <br /> 1 <br /> ACKNOWLEDGEMENT:1 have reviewed this application and confirm the informallOn contained Herein is true and correct.Work done pursuant to this p;nit must comply with <br /> cwront foefor a,riotq ono'lOColbuc The grading of o pormif only oufhorizor approcrp$ac+rk Anel no ctw50Qkrna iherefrnm fl tietinna trim/M.0 he oeifhn'Tad in wrifinp from the <br /> Building Official before being authorized under any circumstance.i am the owner,ori am authorized by the owner of this property to perform the work fp which application is made, <br /> end I comply with the Slate Contraelvrs Law 1 .27 RCW end 20,200A WAC. <br /> City of Everett Orfc 1 Use Only <br /> (D----F I 0 1 PER <br /> 114 0-2,-- "10 <br /> OwnerlAuthorized Agent Signature Date (Revised 5120/2016) <br />