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Mar 08 2017 10:50AM Washington Wat eaters 8663757454 page 1 <br /> • <br /> grr PERMIT APPLICATION <br /> BUILDING /MECHANICAL I PLUMBING I SIGN l 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)everetlepsQeverettwa.gov T www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) A PROJECT SITE INFORMATION /// <br /> PROJECT SITE ADDRESS: 'a l Moms(/Y? N -� _PROPERTY TAX#: Q6�J'?`17OI5 (0C' <br /> LEGAL for new construction: Short Plat/subdivision___ _Lot NC.__ (attach copy of long legal description) <br /> �n CONTACT INFORMATION r (�� ' ,,n <br /> OWNER NAME: / t. i TENANT NAME(if•E.�i�l): l K- tvic )p'\ <br /> OWNER MAILING ADDRESS: :nasal- 3I/D lord 9-2 <br /> CITY 6 - STATE (/�/" ZIP 926.6 <br /> OWNER PHONE: Cf. . •53�.--27' r OWNER EMAIL: -� <br /> CONTRACTOR NAME: 1/060 t 1VUYT tJ w ti---rt-It f-16i 7G 1 $ <br /> CONTRACTOR ADDRESS: srnser I 1I Z._ U f LC111- kV t 5 P6 Lox 5-92b0 <br /> /G� �jJ � <br /> CITY JL?'WI-01 STATE �f IIP q0 t/sOJ <br /> CONTRACTOR PHONE: 42.6--` - L/7/ CONTRACTOR EMAIL: 66-tumLVi7C CZ6fi 1,(L, (0-to <br /> CONTRACTOR LICENSE#(REQUIRED): iaI' I qDp iOP CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): QS d9 <br /> PRIMARY CONTACT: 0 OWNER Ci.CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACCT�NAME' CONTACT PHONE: T 2.✓--gg3-Cf 7/ <br /> ( <br /> .,JUJ1 VaftH Is CONTACT EMAIL: G(J ii#//1,/f{-061L,Om <br /> BUILDING PERMIT APPLICATION /I( <br /> Existing Use of Building: Contract Price of Work:$ 0 v`-' <br /> Proposed Use of Building: Heat Source: Gas ctric ❑Other <br /> Building Type. ❑SFR-Detached ❑SFR-Attached ■i .lex 0 Vluiti-Family-#of Units: ❑Commerclai :In a ��N <br /> Type of Project: ❑New Addition :Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of se 4`MtJ <br /> DESCRIPTION OF WORK: '� r <br /> EcLAAApiLt_ N- 0 /tie ; t 74 / <br /> ASSOCIATED BUILDING PERMIT ii(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn Alteration Repair Typo of Project _New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures it of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> G: ,Pipinp Boiler L,avnlory(Wash Basin) Drinking Fountain <br /> Wdrer Heater Rofrigarnlion Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink& Disposal Grease Trap _ <br /> Gas Range IDucting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: �� Clothes Washer _ Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/BaNMopletc.r Other. <br /> - I _ <br /> • SPt. 'lKLEf /SUPPRESSION S ' Ti`,l1 <br /> Number of Heads I <br /> ACKNOWLEDGEMENT:t have reviewed this application and ronfirm the information ccniained )rein is love and coneci Work done pursuant to this permit must comply with <br /> current federal,slate,and local law The granting of a permit only ant).rises approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any cricuniin nce./ , the owner or!am auiho.'i;od by the owner of this property to perform the work for which application is made, <br /> and I comply rvi"r the Stale Goofier:oas Law 16.27 -, W and 296. 'OA WAC. <br /> r City of Everett Official Use Only <br /> 1 ..ii WI i / 3:747 P ERT(Sit\ .(N,O _(),..- ,2____ <br /> ow <br /> Owr , ,tailor:.r;d Agent:iignudure • Date (Revised 5/20/2016) <br />