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grr PERMIT APPLICAAN <br /> BUILDING i MECHANICAL/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 /> PROJECTSITE INFORMATION . <br /> PROJECT SITE ADDRESS: PROPERTY TAX#: <br /> iC C 9 //afh .51. SE., <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> E_ i ,.,::CONTACT INFORMATION 5.:; <br /> OWNER NAME: C e(.Nt I y.1 C-L C TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ``,��/ g./913 pc,°f A €11 cv e,-r; 1 1 1/ � Y <br /> CnY /3O ,Jh E I( STATE Li A zip I g o 1, <br /> OWNER PHONE: Lf.v2 5 - 7L/ 3--5$ 9 a OWNER EMAIL: <br /> CONTRACTOR NAME: -re e J2 Cl.-,L- C. 4 /e <br /> CONTRACTOR ADDRESS: STREET f 0 1 i -f j, - 71_ S E.:- <br /> en, <br /> en, /% l 4 e 1/ STATE W A ZIP 9 jj C i <br /> CONTRACTOR PHONE: 1.1,2y-- 6 g V'- a fr�JO I CONTRACTOR EMAIL: %C s Z,:e.,.1 P/t,a.:1,, i.�5®y est et71.Cc .4 <br /> CONTRACTOR LICENSE#(REQUIRED):71 CN P/-9 G 85611 Z CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): U5 Jai'6 79 <br /> PRIMARY CONTACT: 0 OWNER ?,ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME:, / CONTACT PHONE: 1-7L r7 - 9 6 g' , c i <br /> • Cj( CONTACT EMAIL: ,c e a c. a A e V e <br /> BU.,.ILDiNG, PERMIT APPLICATION,.,x <br /> Existing Use of Building: Contract Price of Work:$ 146 0-OO r <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ❑Addition 0 Remodel ❑Repair 0T.1. ❑Sign ❑Sprinkler ❑Demoolitionn ❑Chane of Use <br /> DESCRIPTION OF WORK: , e' /a. c e -h e ' Q l e r- t..-i.) a.et `.7.0 L�r h o w r ' <br /> fh� hoeb . t- �y/L , 1320/A30/ Z3foLz g .2v2 85 ,end <br /> O n ft e j U ce//1 e ri cC o 7� . e v ._12 i f>c.,1,, /�"i- <br /> ASSOCiATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL`PERMITAPPLICATION ... ,•:;: PLUMBING:PERMIT APPLICATION N j <br /> Type of Project: _New_ Addn Alteration Repair Type of Project: _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) 1 <br /> Forced Air Systems Unit Heater Bathtub Urinal ( <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain e <br /> Water Heater Refrigeration Shower Floor Drain s <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap 1 <br /> Gas Range Ducting Dishwasher Roof Drains = <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater // Other: $1-0,,,,e, (J,,/ye ( <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) / Other: HD y e 6;S 4 <br /> ) <br /> 133apprgO:KtERIAORPREASIOCAYSTEMAitn <br /> INumber 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./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 I <br /> g — 7— `7 PERMIT#pilot?y 00.1 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> i <br /> I <br />