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PERMIT APPLICATIO <br /> e f , DUILDIN MECHANICAL/PLUMBING/SIGN PRiNKLER/DEMOLITION <br /> s-' � !_: CITY OF EVERETT PERMIT SERVICES <br /> . ,..v''Nii'?`d': 'T 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 i(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> Mai' .®r c9a?P0".0-11k.016:16/PQ04.6) . . ,. . tkOJOCTt #0- IlNl O fi AIrik.N. . ..... . .. • <br /> PROJECT SITE ADDRESS: isD6 '%,t.iL) X i,' PROPERTY TAX#: <br /> LEGAL for new construction: Short Piaf/suhdivision Lot No. (attach copy of long legal description) <br /> • <br /> ...0.017.001.000)01104 . . ... . .... .. .. <br /> OWNER NAME: 49l27-7/(/ it/lETZIK)/X-... �JT <br /> TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: STREET `` CI, ) (f SCZ ©7 L om/ <br /> CIN (�- STATE £L/Q ZIP �L, w( <br /> OWNER PHONE;.,.(44Z.S.) RR— Z71.:70--- OWNER EMAIL: ,..N . ., ..._ ..<..... .,. ..�.<.,. .� ,. .....r ., .<...,.. <br /> CONTRACTOR NAME: C l21t s C te r � ,m� <br /> CONTRACTOR ADDRESS: STREET 2.1.ZO PAA-Q._ tC- <br /> cny e�� LOP,STATE WZIP "�3 <br /> L CEJ <br /> CONTRACTOR PHONE: +25) 2522-- 3((L4 CONTRACTOR EMAIL: (-2-04.-0..g--55 rm c..Jw.-G -llt j <br /> CONTRACTOR LICENSE#(REQUIRED): 1_Uc2e5s0• -r-- #(R j�f} yj <br /> CiTY OF EVERETT BUSINESS LICENSE SQUIRED) <br /> PRIMARY CONTACT: ❑OWNER %CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ( zc) 56 _e <br /> 1La(� CONTACT EMAIL: Va i/t.,(0 e 55„.„7„_„.6„,, <br /> _.BUILDING PERMiT;APPLICATION <br /> ft" <br /> Existing Use of Building: Contract Price of Work:$ . <br /> Proposed Use of Building: Heat Source: ❑Gas $Electric ❑Other <br /> Building Type: 0SFR-Detached ❑SFR-Attached ❑Duplex ❑Mufti-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition OChange of Use • <br /> DESCRIPTION OF WORK: Xsopt`._ (JC�w frk.‘-i-S( 6151 i ((fi ,S'rewt 4°rt Pu.tby r / I)`iL-f i-6-1j' <br /> AF-'I) (i ,c,t (e4to-t.1'r <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ::.Mi GHARS_ICAL PERNII PPIJCATIOiii PLUMBING PERMITAPP . . . .�1..' <br /> Type of Project: •__New Addn _,Alteration _Repair , Type of Project: New Addn Alteration Repair <br /> #of ft List of Fixtures °f List of Fixtures °f List of Fixtures °f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units I Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <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: Clothes Washer Medical Gas <br /> Range Hood i Water Heater Other: <br /> Exhaust Fan i Sink(Service/Bar/Mop/etc.) Other: <br /> `:: sP-~.INKLER-/SU(PP.RIBSSION:SYS`O.E.M.. . . <br /> Number 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.lam the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the State ontractors Law 18. = , and 296.200A WAC. <br /> City ofIEverett Official Use Only <br /> „..4' ��-- ,1 PERMIT lrG il <br /> /2 <br /> Owner/Authoriz d Agent Signature Date (Revised 5/20/2016) . <br />