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3 <br /> PERMIT APPLICATION <br /> '411P00 -::A BUILDING I MECHANICAL I PLUMBING I SIGN 1 SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> Noc' 3200 CEDAR STREET,EVERETT.WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(El everetteps@everettwa.gov wvwv.everettwa.gov!permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 2-574, STn-re- PROPERTY TAX#: <br /> p/10,cmc of Q0S9 3s4,9 Fv Xi o 0 <br /> LEGAL for new construction. Short Platt/subdivision Lot No._.___ (attach copy of long legal description) <br /> CONTACT INFORMATION " <br /> OWNER NAME: /11,4""i1.44,E/d y L/Ai TENANT NAME(If Commercial): /I�.2/MSoi.!Et/E frxtre.AI s <br /> OWNER MAILING ADDRESS: STREET Z9/ 4 51 47e—S-r-. 5I1 i /0 0 (,/ L <br /> CITY V EK EDT" STATE (/V r' ZIP Ct(y.2.D/ <br /> OWNER PHONE: 204 — 57O.- 2s '1I OWNER EMAIL: ittA1124-4 e WES- CoNSTYLuc'VIotJ , tDM <br /> CONTRACTOR NAME. 1 ( ti kiv <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR OTHER(Please Specify) ,A N ULEw 14 ye I S 7 ✓l Cif <br /> CONTACT NAME: //�� CONTACT PHONE: 4-12.6-,- (oq7 - !7 3 cq <br /> K <br /> /4-NID4e C' /C1ST2>c!!CH CONTACT EMAIL:ANDa i v..e,4gA.,„erg 1ft1EVES .G.oM <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building. Wkte HouS E Contract Price of Work:$ 41'2R,te x-S5-0 c' ' . <br /> Proposed Use of Building:CONN Rg IS ?K o D u crl o tJ Heat Source. ❑Gas DElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units %Commercial Dindustrial <br /> Type of Project ONew RAddition DRemodel ❑Repair DT I ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> de,, tic r' " /O he/ o Fo or M u'/ 7-7f II Ti t--it T1 o,v -5 r/ TE.a• 0'..i T K E- <br /> 3 b <br /> 3t11 f Lvc>, _ <br /> ASSOCIATED BUILDING PERMIT#(if applicable). <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of riroject: New __›/Addn Alteration Repair Type of Project: _New zysAddn Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures _ <br /> AJC-Air Handling Units 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 Water Heater Other <br /> Exhaust Fan link(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER/ SUPPRESSION SYSTEM <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 • 'cal I. 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. ore being. thorized under any circumstance I am the owner.or I am authorized by the owner of this property to perform the work for which application is made <br /> and I comply t h the State 'on : tor:Law 18.27 RCW and 296 200A WAC <br /> City of Everett Official Use Only <br /> PERMIT# <br /> .f . dit t is rb v,rc 3 -9 -fp e7 l C'- - 0 38 <br /> Owner/Authorized Ag: gnature /]4'2,v Date (Revised 10/12/2015) c 1 <br /> A0 360-"/7-qoo 3 <br />