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0 <br /> (//-- -';''''''-,/..,... UGG..DGNG / GidECHANGCAGL�� =:IPdd1_lG-Vil da GGG\'9CL8. (!1:= I S <br /> PRNKLER I D iliio1.11IGoNf CIT Y OF EVF:RETT 'ERMfT SERVICES <br /> C'l7 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 /> (Blare or `•_lack Ink vnlly Please) PROJECT SITE INFORIUlATIO I 1 <br /> PROJECT SITE ADDRESS: I an.1 /99 147 4/7. c,f, e tfildAPROPERTY TAX#: 'le of 2 2p3 4oc) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> - <br /> CONTACT INFORMATION <br /> OWNER NAME: /441,1/‘/ ie/AJ 1 ?)/i/j ./4/A3 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /6.30 q f F 71h ,.f7r2.r►-e7, <br /> CITY 1(9-74-10tr v e- STATES 1,4„..• A- ZIP P g ad g <br /> OWNER PHONE: OWNER EMAIL: pry( �� <br /> c� tv��1 I�vw� ��� 41. ' Ldr.; <br /> CONTRACTOR NAME: T. 4& _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: 0 OWNER 0 CONTRACTOR ( -OTHER(Please Specify) A-P.G.t-{ ( Tc C f <br /> CONTACT NAME: vs',r' J"r.-t,e_sit t CONTACT PHONE: (e-/-t 5) _5..2_ - 2 I 5-3 <br /> .r� <br /> *2-�i r2, /4(t.C -t 1 -pa-- 7 C. u s.c. - CONTACT EMAIL: y^. 'S q.,tl �2 C4,4- •+'-Ci-4 . .C. <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: S t h.-1 l.e /rye-C,'44-e pi L t_ - Contract Price of Work: $ <br /> Proposed Use of Building: r o w N E'i o 1f. Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached FR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> to r '2 u r 6; a`17_ 1 1 Li tv 17 Taw N et 3 v.S' C 0 et /'" L t? ,< <br /> -/ I 1,1 fh Lid 2 n L 4-i.__ r crt 14.4 (—Me re-s1 it. _ v N 1. t <br /> ASSOCIATED BUILDING PERMIT#(if applicable): ( ',loc a -£ &if i/) <br /> MECHANICAL PAPPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New _ Addn Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> • <br /> A/C-Air Handling Units Heat Pump 2. Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems f Unit Heater ( Bathtub Urinal <br /> Gas Piping Boiler 2. Lavatory(Wash Basin) Drinking Fountain <br /> / <br /> Water Heater Refrigeration ! Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range • Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> _ / Range Hood ' Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM _ <br /> Chemical or Water i No. 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 /> 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 l 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 /> PERMITC/.(\ ga-t--..----__ [ v 004-0/q <br /> Owner/Aut orized Agent Signatu•e Date (Revised 9/23/2016) \ <br /> I <br />