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PERMIT APPLICATION <br /> BUILDING I MECHANICAL i PLUMBING I SIGN I SPRINKLER I DEMOLITION <br /> .:::-.#.,--:::-.A' 71. <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 ( FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS:3" Wls PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision �[ Lot No. (attach copy of long legal description) <br /> an_t.'_: , O..w:v OOlita T:iHIFORMA'P,IOtd, ,:,,...`t,...x :lt < _.,._ <br /> OWNER NAME: 1...-700-41 C.r-✓ .„ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET <br /> CITY STATE ZIP <br /> OWNER PHONE: `}'ZS '--eISZ'" S4� OWNER EMAIL: tt . <br /> CONTRACTOR NAME: 4)()1kc� �jt,l.l�'lbf 03 LLL <br /> CONTRACTOR ADDRESS: STREET n<t(Y -- I- + <br /> CITY (l... ,V\I� STATE kA- ZIP .1 g 2_ <br /> 4116 : <br /> CONTRACTOR PHONE: 2}25-3S1 '5 <br /> - tD1 CONTRACTOR EMAiL: dljbt ,apt k b'pl W rilo i r'lat . 0". 7't--i <br /> CONTRACTOR LICENSE#(REQUIRED): 110)b LC?) GI 0.2 i.-T CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED) 'r 663 <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 34 OTHER(Please Specify) b P r\C L U, Y1oic4 E_7 1%4/• g <br /> CONTACT NAME: em CONTACT PHONE: A26- 6601 • 51'2-6 <br /> Te-001-t- tksSe 1 CONTACT EMAIL: dea®bie tape,e, t 1 t.1) ?i LIMO i i'ln <br /> `- B,UIi.DING?PERM__1T'=1®&PPL1.amst tp '-i <br /> Existing Use of Building: V►2 Contract Price of Work:$ k <br /> Proposed Use of Building: j lie., Heat Source: ❑Gas Electric DOthe <br /> Building Type: R-Detached ❑SFR-Attached Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New ©Addition ❑Remodel epair OT.I. ❑Sign OSprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> egtipcft dug/t?qq +0 va,nd� s a,l l co owl 04_ h� <br /> aM i rep keit lt t1..+'\21�irs i zeiL w 1 t h.2._ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> 00:0I"N::GAIo titgi .-APP.l-W.TION ."_ gentad PLUMB1NG1PERM T APPLiCAT't9NPM__ _._. __ <br /> Type of Project: New_ Addn Alteration Repair Type of Project: New Addn 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 /> • A/C-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 l! Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: yClothes Washer Medical Gas Ii <br /> Range Hood V Water Heater i Other: tyPai€_t.. SC(Vt_-G (j <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> il <br /> -,OPI21M6CLEIt':I S PPRE_SSpO aYSTti�l <br /> t nn <br /> ,- 'Number of Heads <br /> , <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,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.lam the owner,or I am authorized by the owner of this properly to perform the work for which application is made, <br /> and!comply with the Stantractors Law 18.27 RCW and 296.200A WAC. <br /> r(e. <br /> lit 1.,‘- 2)/Zo i ) ib <br /> City of Everett Official Use Only Pl!'# \%403 ..-03 <br /> Owne Authorized Agent Signature Date (Revise. 10/12/2015) <br /> - t <br />