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_..., <br /> 416-77. PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING/SIGN I SI;...IKLER/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)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS q 53 <br /> to , ,t ,y�r .4 PROPERTY TAX#:dog i i o oo Zoo 56 z <br /> LEGAL for new construction: Short Plat/subdivision � Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: I Tud ir,S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET Ct yO 14)6414inibr1 PC etc e, <br /> Cn'r ThiarAteeri STATE to/T ZIP Q c Z l <br /> OWNER PHONE,-/,ZS) 3 Sq- C c9ej' OWNER EMAIL: <br /> CONTRACTOR NAME: 74 iia ® l, <br /> CONTRACTOR ADDRESS: STREET PI () 6 <br /> It 7 /33v 0 13E iffy!&icy 4136 C <br /> crry 1Jt Cita/ STATE 'toA- ZIP fits a <br /> CONTRACTOR PHONE: 266 7 X -3 gerCONTRACTOR EMAIL:`'( oi ,Lyc,-C?j s 40 &*vr- <br /> CONTRACTOR LICENSE#(REQUIRED): 602, qui 17 1 Ay 7 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED' b�5l.23 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR p-OTHER(Please Specify) <br /> CONTACT NAME: `' C,u2 j664, CONTACT PHONE: ZOL 3k7- 2,7q <br /> CONTACT EMAIL: 1cud.. AP . 0 yeei Aid , cc,w, <br /> - BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: ,/; .,,/f dente._ Heat Source: OGas tittlectric DOther <br /> Building Type: i SFR-Detached [ SFR-Aftached DDupiex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project C2fiew DAddition DRemodel ©Repair DT.I. DSign C)Sprinkler ODemolition DChanne of Use <br /> DESCRIPTION OF WORK: `s ta< s i/J6,./e ki-✓►'r i 47 /kola <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION: . :- <br /> PLUMBING:PERMIT APPLICATION <br /> Type of Project New, Addn Alteration _Repair Type of Project New Addn =Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures List of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Air Handling Units Heat Pump y Toilet Backflow Preventer(Inside Bldg) <br /> / Forced Air Systems Unit Heater ,Z Bathtub Urinal <br /> ( Gas Piping Boiler S*10 Lavatory(Wash Basin) Drinking Fountain <br /> / Water Heater Refrigeration A 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 Other. <br /> t../ Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER F SUPPRESSION SYSTEM . <br /> Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confin n 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.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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> oli <br /> " ,/211614 C 01- 0Q( , �_ <br /> erlAut rized Agent nature Date (Revised 10/12/2015) —VT <br />