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PERMIT APPLC�­ION <br /> BUILDING/MECHANICAL 1 PLUMBING/SIGN I SPRINKLER I 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@everetNva.gov 1 www.everettwa.gov/permifs <br /> ff <br /> aai�Cs ll>1a ®�u6 >t� sip P ® ISiSIT1 L�_ �TE ADDRESS: CVf 14 Z,ze Y1 `` " PROPERTYTAX#: <br /> w construction: Short Platlsubdivision Lot No. (attach gopy of long legal description) <br /> OWNER NAME i2.t C l TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET V 2�-t IZ 'Z <br /> MY �V(�.K. STATE LLA <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR <br /> CONTRACTOR ADDRESS: STREET Zt7_0 AC.s t C. <br /> CITY STATE WA Z(P 61 V20 t <br /> CONTRACTOR PHONE: ( Z 2aZ- f j r-f CONTRACTOR EMAIL: �° +s+.Q. f+►'t f«Ca.r C iJ <br /> CONTRACTOR LICENSE#(REQUIRED): L'vGQ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: [ OWNER� )ACONTRACTOR 1]OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: VT) Sd 0-7 <br /> �� tJ CONTACT EMAIL: �Q2 ��S%}'Jxtt •[lid <br /> :,BUILDING-PI RMITAPPLiCATION <br /> Existing Use of Building: Contract Price of Work:$ i <br /> Proposed Use of Building: Heat Source: as ©Electric ❑Other <br /> Building Type: SFR Detached ❑SFR-Attached ❑Du lex 0Multi-Family-#of Units: ❑Commercial 11 Industrial <br /> 11 <br /> Type of Project: EINew ❑Addition ❑Remodel DRepair ❑T:i. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION OF WORK: t � „A6~rzttt.' t (JLj{�[ tLKcXL— 1 �k1�t <br /> ASSOCIATED BUILDING PERMIT# if applicable): <br /> IGAT 4®� PLUMBING P1ER �6`➢'.�i00Q'C't T10lid <br /> Type of Project: _New_ Addn Alteration _Repair Type of Project: •New _Addn Alteration Repair <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> rp(tures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units Heat Pump Tniiet Backflow Preventer Onside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Wafer Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher <br /> Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Otfier. <br /> ...: s <br /> SPRINKLE <br /> P.-/SUP?IP'����a®jtll.Sl'S� <br /> Number of Heads _— <br /> ACKNOWLEDGEMENT l 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.Devietiona must first be authorized in writing from the <br /> Buffdfng Official before being authorized under any circumstance I am the owner,ori am authorized by the owner of this property to perforin 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 Ofcfal Use Only <br /> X12 =1T <br /> Owrner/Authorized Agent Signature Date (Revised 5/20/2016) (, <br /> i � <br />