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UM (TTS /'t- Er410 <br /> Oxienr • PERMIT APPLICATIOKO <br /> r� <br /> BUILDING /MECHANICAL I PLUMBING / SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 • <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Llano orr [ lack Ink Only Please) PROJECT SITE IRIPORIIV ATION <br /> PROJECT SITE ADDRESS: )5 Dun units A-4 B PROPERTY TAX#:(j)(`22 9 2SO'O(- 9 l 6c- <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> C NT 1 CT INFO lilfliATl®M <br /> OWNER NAME: tDLJAd AJ AfN 0 /TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I t I �`S L ' \N <br /> // cmv STATE4 \ AZIP ��2'1 <br /> OWNER PHONE:&4c) ‘92` ' • O`)''74 OWNER EMAIL: .0OA AV fl,bcq 3t, a c.l'1/1.A1 L r C(j M <br /> CONTRACTOR NAME: 0 If'0t C l ` 0 (L V [ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: lEf"OWNER ❑CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> L <br /> —_ WILDING PERMIT APPLICATIOB •- -� <br /> Existing Use of Building: Contract Price of Work:$ -✓ ,�✓I <br /> Proposed 17se of Building: "FLEX Heat Source: 'Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached [Zuplex ❑Multi-Family-##of Units: ❑Commercial ❑Industrial <br /> Type of Project: lew ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): L' 0 IT. A 4 <br /> ilfv1ECHARIUC lL PERMIT APPLICATIOR5 PLUMSIBIG PERMIT APPILICATIORi <br /> !Type of Project: _New Addn Alteration _Repair i Type of Project: New Addn _Alteration Repair <br /> #of #of ! #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures 1 Fixtures List of Fixtures Fixtures List of Fixtures <br /> A/C-Air Handling Units Heat Pump r��Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater <br /> Gas Piping <br /> Ma.Bathtub Urinal <br /> Boiler Lavatory(Wash Basin) Drinking Fountain <br /> _ 'Water Neater Refrigeration C�Shower Floor Drain <br /> Gas Fireplace —Wood Stove '©Kitchen Sink&Disposal Grease Trap <br /> ,2 Gas Range Ducting MO Dishwasher Roof Drains <br /> NMI Clothes Dryer Hookups =Other: MIN Clothes Washer Medical Gas <br /> 2 Range Hood ��._,7,4r,r1=1.: : Other: <br /> Exhaust Fan 1 Sink(Service/Bar/Mop/etc.) Other: <br /> 1 SPRt5 IX JER/ SUPPRESSIMI SYSTEM <br /> NMChemical or Water No. of I leads i_ <br /> -_.._.... _____ <br /> ACKNOWLEDGEMENT' - • �Y.---_._ L — --.—, 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 I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT <br /> .3 ig/2..e i 6 <br /> ier/A7•;:: <br /> ent Signature Dateb.,1 A <br /> (Revised 9/23/2016) <br /> ,(7\ <br /> �I2 <br />