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10/30/2017 MON 15: 04 FAX Faat w/tter Heater IZ008/008 <br /> PERMIT APPLICATION <br /> Ib� b1,9 <br /> /1.-4111'..--,,,,,,.,, ,-A-- BUILDING /MECHANICAL/PLUMBING/SIGN I SPRINKLER I DEMOLITION <br /> - CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)426-267-8810 I FAX 426-287-8887 I(E)evereltepaC�averattwe_gov I www.evereltwa.gov/permlls <br /> - - .. , <br /> Blue or Black Ink Onl Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS q5 (( pp, PROPERTY TAX#: 1 r / 0 , ,o o 00 <br /> LEGAL for naw construction: Short PlsVsubdlvlslon `� Lot No. (attach copy of long legal deacrtpllon) <br /> CONTACT INFORMATION <br /> • <br /> OWNER NAME: PUT V4.EA' A-M N Poc,K TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: smear 01I,50,5 i () r7 r)g //� �J /���/ <br /> cell/r 4! afar: 4/V7 1 am I CSV -1 <br /> OWNER PHONE; (' 5 D I-45 c. q( !OWNER EMAIL: -r <br /> CONTRACTOR NAME: i Si ! A' .---1,T f <br /> CONTRACTOR ADDRESS: sraeE_r 11-1-5 N 0{42.U--- -PY---RM S C 1 ()(p <br /> GUY 01"\-- L,.1, STAT. Lkjh ` ZIP 0 <br /> `1 Y '1 <br /> 5 <br /> CONTRACTOR PHONE: (--0 `Q "I1 CONTRACTOR EMAIL:P eW\ \T S (�4l,S�'u)pt01.A. -eJ-. riot/vi <br /> CONTRACTOR LICENSE NREQUIRED):91-sT _WH-C\Liq'gj� !CITY OF EVERETT BUSINESS LICENSE it(REQUIRED)5D L153 <br /> PRINIARY CONTACT: 0 OWNER (,CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: Lip?- / - r * e <br /> • <br /> t /� � <br /> �" -\.- Ua, CONTACT EMAIL: e ' ,Its i ,-,,,,,A,kwkx ,,, <br /> _BUILDING PERMIT APPLICATION <br /> Existlne Use of suIIdlnr: / Contract Price of Work:$ r.. <br /> Proposed Use of Bulldinp: SP 0 Heat Source: j4las ❑Electric ElOther <br /> Bulldiu Typo: FR-Detached DSFR Attached ODupisx 171Mu18-FarnIly-#of Units: DCommerelal Clindustrlal <br /> Type of Project; DNew ElAdditlon ❑Remodel agtRapalr MT.].• 171819n ©Sprinkler ODemolillon DChnn�r e of Use <br /> DESCRIPTION OF WORK: <br /> f 0\l'C l re,p\ALe, C?6-S w ak- V\ c a, e_-r <br /> ASSOCIATED BUILDING PERMIT# If a..linable <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New_ Addn ,__Alteration _Repair Type of Protect: _New p.ddn _Alteration�� __Repair <br /> List of Fixtures Flxturos List of Fixtures Fl Fixtures /tures Llet of F.. -- urea • <br /> List of Fixtures <br /> NC—Air Handling Units Heat Pump To-: Backflow Preventer I _de Bldg) <br /> Forced Alr Systems _ Unit Heater =athtub •=l <br /> Gas Plp1 g Boiler Lavatory(Wash Basin) Drink • Fountai n <br /> ' elk* _Water Heater Refrigeration Shower v Floor Dra • <br /> Gas Fireplace Wood Stove Kitchen Sink-A.Disposal Grease:A <br /> GmRange Ducting 0lshwaoher Roof Dr: <br /> Clothes Dryer Lookups Other: C•• hes Washer Me• •^I Gas I <br /> • <br /> Range Hood - Wafe eater •- • er: <br /> Exhaust Fen Sink(Se - eiBar/Mop/etc.) Other: <br /> SPRIN UI $SIIO FSTeM <br /> arnica!or lc. of Heade <br /> ACKNOWLFDGEM h/T I have reviewed this application and confirm the information conlalned herein la true end correct.Work done pursuant to This permit must comply with <br /> current federal,state,end local law.The aranfing of a permit only authorizes approved work and no deviations therefrom.Deviations meet fat be authorized in writing from the <br /> Suliding Official before being authorized under any circumstance.I em the owner,ori am authorised by the owner of this property to perform the work for which application Is made, <br /> and I comply with the State Contractors Law 18.27 ROW and 296 200.4 WAC. <br /> City of Everett Official Use Only <br /> f4418_ /, / lo 3� I� PERMI\din lI� 00 2 / <br /> .r• .0. <br /> Own= •Labor za A011t Signature Date r(Revised 9123/20> <br />