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Mt.?, <br /> ' �+ (P)425-257-8811— AX 425-257-8857 1(E)everetteps@I www_everettwa.gov/permtts <br /> Iuie ®r black Ink®.nw.rIease) j PR®�l 1 <br /> t` iINFORMAPION __.______-__-- ---- <br /> /� -- <br /> ROJECT SITE ADDRESS: ' Ze26 a& :r/Z / PROPERTY TAX#: <br /> GAL for new construction: Short Plat/subdivision _ _ Lot No_- `(attach copy of long legal description) <br /> - . CONTACT.INVFORMATION . • —_-- <br /> WNER NAME: b�a N HALk16441 0-14 TENANT NAME(If Commercial): <br /> WNER MAILING ADDRESS: STREET I 'Z 12-( Ue- kJe- 546 zcx, • '/� ZIP q b C��� <br /> r� / STATE L A <br /> CITY �.JC��c�-�ll(,{CJ <br /> OWNER EMAIL: <br /> WNERPHONE: (`-lZS1 57`�l � c& .._,........ _. ......_..._.. .._ .,__. ... _ ,..,.__._ .... . ., <br /> ONTRACTOR NAME: E 04.•Ye-Gvu 5Tia--af c WtArc- <br /> ONTRACTOR ADDRESS: STREET '2-(' --O 1-( 1 AU 61 <br /> CITY e vGYW STATE W A- ZIP 6/6320/ <br /> ONTRACTOR PHONE: 4-2-5-2,s--2-"-51 14 • 'CONTRACTOR EMAIL: <br /> CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Ga 6-7-L 5-5 <br /> ONTRACTOR LICENSE#(REQUIRED): �vC�S�p'�Lv "� ._._...............:........_ ............__.............,.,...,..._.-_.. ._-�..... ...._......_..., <br /> RIMARY CONTACT: 0 OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> DNTACT NAME: CONTACT PHONE:{7 c-2.52-'11�/ <br /> CONTACT EMAIL: <br /> . . BUILDING PERMIT APPLIGATI,ON • . • <br /> cisting Use of Building: i <br /> Contract Price of Work:$ 364), C' <br /> •oposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> gilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: <br /> [Commercial ❑Industrial <br /> ,pe of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler El Demolition El Change of Use <br /> ESCRIPTION OF WORK: <br /> e_ C -LT (2- a Lc-wc 6._- 1-t,t_czr.A %5 (1:--4 k& -o 1.—c kt:-5j <br /> ;SOCIATED BUILDING PERMIT#(if applicable): - - <br /> ' 11((BOMANICALPERNIIT APPLICATI®� <br /> PLUMBING PERMIT APPLICATION • <br /> pe of Project: New Addn ,Alteration Repair Type of Project: New ^Addn _Alteration Repair <br /> T <br /> of =f of #of List of Fixtures <br /> #of List of Fixtures List of Fixtures Fixtures <br /> List of Fixtures Fixtures Fixtures <br /> xtwes Toilet Backflow Preventer(Inside Bldg; <br /> A/C-Air Handling Units Heat Pump Bathtub Urinal <br /> Forced Air Systems Unit Heater <br /> Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Gas Piping Floor Drain <br /> Water Heater Refrigeration Shower Grease Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Trap <br /> Gas Range <br /> Ducting Dishwasher Roof Drains Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood <br /> Water Heater Other: <br /> Exhaust Fan Sink (Service/Bar/Mop/etc.) Other: <br /> SPI IN(LER/SUPPRESS1ON SYSTEM <br /> (Number of Heads — <br /> KNOWLEDGEMENT.'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 /> rent 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 <br /> is mac <br /> the <br /> Iding Official before being authorized under any circumstance. I am the owner, or I am authorized by the owner of this property to perform the work for which app. <br /> I i comply with the State Contractors Law 98.27 RCW and 296.200A WAC. -, City of Everett Official Use Only <br /> I ) ., -! PERMI ' n '1 l L...00 C0 <br /> /C- 1 —1-711lI YY II <br /> ,.,,,rrn,Tfl,;,rik Anent Signature <br /> Date (Revised 5/20/2016) <br />