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Sep 06 2017 12:11PM Washington Wateraters 8663757454 page <br /> OLTPERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.govfpermits <br /> (Blue or Black Ink Only Please) 6-14-- <br /> PROJECT SITE <br /> *A-76 <br /> j <br /> ITTE�INFORMATIO INFORMATION <br /> TAX#:QjOyg3(lV� �� <br /> PROJECT SITE ADDRESS: n?if(- re^i-,�I.J t t 1 ' Q" r 1 <br /> LEGAL for new construction: Short Plat/subdivision_ Lot No. (attach copy of long legal description) <br /> Nora__/� CONTACT INFORMATION <br /> OWNER NAME: 1-1-e,t ' Nv{6k //� p� TENANTTE{� NAME(If Commercial): — <br /> OWNERMAILINGADDRESS: sTSEeT �3 610- 4t/� N ► -t 470 <br /> V � � �1 4- <br /> STALE (/l! �T uY �f: <br /> �[��y carr ! p <br /> OWNER PHONE: 14r/—Z '? 7(465f TOWNER EMAIL: n • <br /> CONTRACTOR NAME: f,/045►'[1 A)� ► vN W A-� t H T6-reS <br /> r`t15 Z t t G"A- A-VC 5E — P6 130XS/2L <br /> CONTRACTOR ADDRESS: srRECT �,f� 21P ��5�' <br /> 426-40-CITY be l j Irl STATE y� C. ! /,t <br /> CONTRACTOR PHONE: y1 '7/ p`�/� 'CONTRACTOREMAIL: a)f}yif-HVf U�IVU1iL-1 (9/ <br /> 4 <br /> CONTRACTOR LICENSE#(REQUIRED): t/U/•r kgSUUf ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05 39/1011 <br /> PRIMARY CONTACT: ❑OWNER )(.CONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME;,, CONTACT PHONE: , T3-La 7/ <br /> IS (CONTACT EMAIL: t.69--W,- n,j. eI6loo-1L,((rY <br /> �-cC I r-� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: 000 -- <br /> Proposed Use of Building: <br /> �Heat Source: ❑Gas tric CI Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: <br /> ❑Commercial ❑Industr <br /> Type of Project: New Addition ❑Remodel ❑Repair ❑T.1. ❑Sign ❑Sprinkler ODemolition DChange of Use <br /> DESCRIPTION OF WO�R�K:,, n \ (AZAPU7 l' °6( (- -1/ <br /> 'R <br /> L IL <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION , <br /> Type of Project: New Addn •_,.Alteration Repair Type of Project: New _Adds _._.Alteration Repair <br /> #or >4:of #of #of <br /> List of Fixtures List of Fixtures List ofList of Fixtures <br /> Fixtures Fixtures <br /> Fixtures Fixtures Fixtures <br /> Toilet Backflow Preventer(Inside Bldg) <br /> A/C-Air Handling Units Heat Pump Urinal <br /> Forced Air Systems Unit Heater Bathtub <br /> Gas Piping <br /> Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace <br /> Wood Stove Kitchen Sink&Disposal Grease Trap Gas Range Ducting Dishwasher • Roof Drains <br /> Clothes Washer Medical Gas <br /> Clothes Dryer Hookups Other: ' Other: <br /> _Range Hood Water Heater <br /> Exhaust Fan Sink(ServiceiBar/Mopletc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM --- <br /> 'Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true ape con rut WW1,.A.,.,purouent b Thin pormil must nnmNy with <br /> current federal,slate,and local law.The granting of a permit only aJthorizes approved work and no deviations therefrom. Deviations must first be authorized in writing from the <br /> nuilding Official before being authorized under ney circumstance I: the owner,or I em authorized by the owner of this property to perform the work for which application is made, <br /> . .1 with the State�pniactors Law 18,27-CW and 296 ra WAG. City of Everett Official Use Only <br /> Il `• . 6( / I ? _ _l PERMIT# . ( "1D [ 'oil' <br /> Ow Authorized Agent Signature <br /> Date ` (Revised 5/20!2016) <br />