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12/19/2016 10 : 54 #1454 P. 001/002 PERMIT APPLICATIOty /111W----A. BUILDING / MECHANICAL/ PLUMBING I SIGN / SPRINKLER I DEMOLITION CITY OF EVERETT PERMIT SERVICES Niiii, 3209 CEDAR STREET,EVERETT,WA 98201. (P)425-257-8810 i FAX 425-257-8857 1(E)everetteps@everettwa.gov i ww w.everetiwa.gov/permits . PROIECT:SITE'INFORMATI:ON PROJECT S T 2ESS: kl vrittifet, gab U� PROPERTY TAX#: i _ LEGAL for new construction; Short Plat/subdivisionLot No. (attach copy of long legal description) . '. ,CANTAc ItiORMAT1ot OWNER NAME:A/VJ / siPf / TENANT NAME(If Commercial): OWNER MAILING ADDRESS: STREET 2 - - kty coy " 'II ' i STATE A A/ 21P 7,e/CY OWNER PHONE: �j"t+fr P OWNER EMAIL: C CONTRACTOR NAME: / ,I S CONTRACTOR ADDRESS: srRCE'r✓a 0( £/// Id/ • Cri' EVA" it STATk Z1Ple4:®1 i CONTRACTOR PHONE: 2v 2J(., CONTRACTOR EMAIL: sss�� p CONTRACTOR LiCENSE#(REQUIRED): ' .�' rJ' 1 ' L. CITY OF EVERETT BUSINESS LICENNSSE#(R``EDUIRED)(')/ .> b ' PRIMARY CONTACT: ❑OWNER ❑CONTRACTOR PI •THDR(Please Specify) 1,30Hk( 0071-}1E-7 ,_..... ' — CONTACT NAME: CONTACT PHONE: ti2_,,‹ ...2.3/ ,Z.2 cd Y[ &L--0 " CONTACT EMAIL: ,M BUILDING PERMIT APPLICM'ION Existing Use of Building: s p Contract Price of Work: $ 0Q.a Proposed Use of Building: Heat Source: IIGas ❑Electric ❑Other Building Type: I:SFR-Detached OSFR-Attached DDuplex ❑Multi-Family-#of Units: -.. QCommercial IDIndustrial Type of Project: ONew ❑Addition QRemodel DRepeir LT.I. DSSign_ ❑Sprinkler DDemolition LChenge of Use — DESCRIPTION OF WORK: ( p LM 1 d F1L_U AC ASSOCIATED BUILDING PERMIT#(if a..licable : Typeo:MEGHANiCAL:PERMIT. #PPL.ICATI:ON: PLUMBING. PERMIT APPLICATION f Project: Now , Addn Altoration Repair Type of Project: _New Addy, ,Alteration _Repair #of fast of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures Fixtures Fixtures Fixtures Fixtures _ .4/C-Air Handling Units r- Heat Pump Toilet Backflow Preventer(Inside Bldg) Forced Air Systems Unit Heater _Bathtub , Urinal Gas Piping Boiler _ Lavatory(Wash Basin) Drinking Fountain Water Heater Refrigeration Shower Floor Drain Gas Fireplace Wood Stove •Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas Range Hood Water Heater Other: Exhaust Fan Sink(Service/Sar/Mop/etc.) Other: SPRINKLER.i..SUppMRESSION;SXSTEM,; 'Number of Heads 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 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 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, and i comply with the tai=Contractors LAW 13,27 ROW and 295.200A WAC. City of Everett Official use Only /soZ, /7 7' litrEMPIAll► Owner/A T..' :.. • gen nature Date (Revised Is 12/2015)