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tiUILUIN / Ivi ii! IVll../- 1_i ri..virwnw , ♦JIVi II . Vi ....mit.mss... �_ - <br /> fq4lEir CITY OF EVERETT PERMIT SERVICES <br /> pp 3200 CEDAR STREET,EVERETT,Wil--I <br /> (P)425-257,I N_I I I FAX 425-257-8857 I(E)everetteps@everettw— I i www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION:. , <br /> PROJECT SITE ADDRESS: - . �,,,Vr PROPERTY TAX#: 2c-fa) f Q® ZIS�O�. <br /> 1I s- t Oho.11e.- i` ?-. tps e.L.- <br /> it LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION , , <br /> OWNER NAME: E H-6 S En/101 (VDUs j a X I I up TENANT NAME Of Commercial): <br /> OWNER MAILING ADDRESS: STREET O .O. , `(B OK I..c----/ - <br /> CIN �t`Cr e...-At <br /> L ., e - STATE Li Pr ZiP 1 52_06- f f T- <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: i A' C9cO°irR_ 7,,g- roRp'L64- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE:-1-€..2„--r 6?..3-(2-71 '425' 2- - -51 13 <br /> z Li L-1--o-3 CONTACT EMAIL: t"q ructc,i Iia a rte/(1 4 . O4-15 <br /> 1 <br /> BUILDING PERMIT APPLICATION <br /> 3"5. <br /> Existing Use of Building: <br /> Contract Price of Work:$ 4 4'4, .07 <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New DAddition ❑Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRiPTION OF WORK: -14,1r7--).4:c�3 ,@d 519*-IS n di P� �S (� t r''�; .--',..3 - <br /> C-104-c Pi-c_c_e)S u r3 L t7K'iU tr- <br /> • <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> PLUMBINGN <br /> Type of ro Project: _New _ Addn Alteration _Repair Type of Project: _ PERMIT'APPLI;CATION <br /> MECHANICAL PERMIT APPLICATION <br /> New Addn Alteration _Repair <br /> #of #of List of Fixtures <br /> Fixtures List of Fixtures #of #List of Fixtures of List of Fixtures Fixtures <br /> 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 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 Sink(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,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 it the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> I PERMIT# <br /> 3JJOJIw (&)03.. 005 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015) <br /> 4 <br />