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IJUILUINI i IVlmI,fMimm...PU..r r Louivwuw , .,....... , ..... .........—.e._, — <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA I `)()l <br /> (P)425-257- FAX 425-257-8857 1(E)everetteps@everettw I 1 II.L www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION : , <br /> PROJECT SITE ADDRESS: - . ,r PROPERTY TAX#: ct(LS j 4 co 2_1_S-0 0 0. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION . , _ . <br /> OWNER NAME: E r}el S E JV I Oil- (-f DUS 1 t3C5 i L LLp TENANT NAME(if Commercial): <br /> OWNER MAILING ADDRESS: sTREEr --P.6 . �1(3OK f T i ? c L <br /> CITY tl�.. -e �' f r`'STATE ` <br /> ZIP 82_0 6- / .7- <br /> OWNER PHONE: OWNER EMAIL: .,. .___ . . .... ,. <br /> CONTRACTOR NAME: '')/A- 0(4),OER ? ?F k/nC`%r . <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: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) / <br /> CONTACT NAME: CONTACT PHONE:`f -- O J ,`-f Lr-1 L�= 2.:9" —5b 1 3 <br /> z L 02_2_ L_YO 1 CONTACT EMAIL: r fu01,c i In a e__•/It ®4 . C::,,r-i <br /> BUILDING.PERMIT APPLICATION <br /> ; U o� <br /> Existing Use of Building: Contract Price of Work:$ 6 4,4 • (o 7 , <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR Attached El Duplex ❑Multi-Family-#of Units: El Commercial El Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. El Sign @Sprinkler CI Demolition El Change of Use <br /> DESCRIPTION OF WORK: ��tx1 1447_34;C,i c30...4 5%01 <br /> •.s S l 4, p -NS Ld t. r-`' ''r S . <br /> f i.04.?(14-Is ps Ce-E fj i I;Le 10 A-ii-(k 1 N U- <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> APPLICATION N <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT <br /> Type of Project: New _ Addn Alteration Repair Type of Project: New _Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures <br /> Fixtures List of Fixtures #of List of Fixtures #of 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.t 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 /> PERMIT# <br /> 60 (0003- 00(0 <br /> Owner/Authorized Agent Signature Date (Revised 1 /12/2015) <br />