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PERMIT APPLICATION <br /> BUILDING I MECHANICAL/ PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> gialit_._. ,.:_ t :.,...__._ ,:. _�P.ROJECTSITEaNFORISi'1ATION .....: >4:k. --AM: <br /> PRT�SIJ.� •- Ov- PROPERTY TAX#: ~ <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> EDOIEBEVTASSESEIVEMMEEIICEMNTKIIOAIWOIIMKTAIIWEZNRIEEIIRNSEEEIANNNMEINRNRVRAV <br /> OWNER NAME: r, 1IA/lij f,0 LihiTENANT NAME(If Commercial): <br /> OWNER MAILING ADDRES: STREET / /7-* Z a�J&.JL (Sy se_ <br /> CITY tv.�v.e` STATE /a/, < -O�a <br /> ZIP yO7- <br /> OWNER PHONE: Z ffF� OWNER EMAIL: (V/` .-a � <br /> CONTRACTOR NAME: Poso -()Ad, (^A..5 p �r 'v <br /> CONTRACTOR ADDRESS: STREET y J �® -3 c__� 9 ^� <br /> CITY ✓..i1 0./I?/7s/i�''t STATE z) ZIP -R92_ <br /> CONTRACTOR PHONE: 72_57----71& —0 -f°/ r) CONTRACTOR EMAIL: /C5 1Cgrj�y �^fv�a�r I i ��_.... <br /> CONTRACTOR LICENSE#(REQUIRED): � ?,.5../iv CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): �,5 (L <br /> PRIMARY CONTACT: OWNER 0&NTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: f p / MLA/LA/e CONTACT PHONE: (.'a �^ a47 3. Cf,4 q 7 <br /> .. CONTACT EMAIL: <br /> kola �S�d �c�ruc <br /> a` --_.._ .r.„u:::. t f>,. BUILDING`PERMIT,APPLI.CATION , EnkihAffdgfiWS <br /> Existing Use of Building: Contract Price of Work:$_4449 0_O <br /> Proposed Use of Building: Heat Source: DGas lectric ❑Other <br /> Building Type: SFR-Detached OSFR-Attached ODuplex OMulti-Family-#of Units: ElCommercial El Industrial <br /> Type of Project: ONewddition El Remodel El Repair DTA. OSign OSprinkler CI Demolition OChange of Use <br /> DESCRIPTION OF WORD <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> SMECHAN)CAL'ERNIIT,APPLICATION n2 PLUMBING,.PERMIJ APPLICATION _ _,:; ; a�.,: <br /> Type of Project: New—F Addn Alteration Repair Type of Project: New Addn Alteration _Repair <br /> #of #of #of • it of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 lig., Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> _ <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 Sink(Service/Bar/Mop/etc.) Other: <br /> > D�� <br /> ,.,;'SPRINKLER-I SUPPRESSION_SYSTEM, '..„St <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,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 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 /> ,� : <br /> O er •*�''orized Age Signature Dat: (Revised 10/12/2015) <br />