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41e7rD ORIGIN/I PERMIT APPLICATIOII
<br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER/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 /> tin .. ._.,` -?x r . ROJECT SITE INFORMATIONMl gp£ ..,. k.. :
<br /> PROJECT SITE ADDRESS:-5\(3 Et li ^ 31- PROPERTY TAX#:N'/�/j6/O/')/�y�T2/�/�
<br /> LEGAL for new construction: Short Plat/subdivision Lot No. Jl,( (attachJcopyoflong legaldescription)
<br /> .2 ,_._._ _# 'iF: w, : <r n . . ONTACT IN_FOR:MATION .. . . t�
<br /> OWNER NAME:/ er ICS Marti n eZ TENANT NAME(If Commercial):
<br /> OWNER MAILING ADDRESS: STREET,, `ci E.-1,n k -"\-'
<br /> // Cnv EV�� 777 STATE/ (w,�,/ ZIP q 0 203
<br /> OWNER PHONE: 1-{3-•"MI 0361111 OWNER EMAIL:�it)1(11S, C. IAA(fin 1274 S.f vv-
<br /> CONTRACTOR NAME: 13 Flo
<br /> CONTRACTOR ADDRESS: STREET j Z7 -WI Stu) #
<br /> CITY )01(1-1-1(1 V �, I/ ra e STATE (A)71-- ZIP eiga
<br /> CONTRACTOR PHONE: L ` --7 CONTRACTOR EMAIL: i , JJJ 111 VVV
<br /> I -1 \ 3 IC �U�e�10►��or��a�l--�o
<br /> CONTRACTOR LICENSE#(REQUIRED):„Lu C j EFt)2 �, CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):667
<br /> PRIMARY CONTACT: 0 OWNER .'CONTRACTOR ►J❑/OTHER(Please Specify) ���✓✓✓
<br /> CONTACT NAME:
<br /> CONTACT PHONE:
<br /> t a:1i tt —1 I' 6
<br /> Mira V1
<br /> / a /1kjeag, CONTACT EMAIL: (n1-U6-21010,1i,ony&rnpeiv+, y
<br /> 7
<br /> SC sAR .0 .o . BULDINGPERMIT7APLICaATIONam ,, > '
<br /> .
<br /> Existing Use of Building: Contract Price of Work:$ 79
<br /> Proposed Use of Building: Heat Source: ❑Gas (ectric ❑Other
<br /> Building Type: 447FR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial
<br /> Type of Project: ❑New t$Addition 0 Remodel ❑Repair DTA. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use
<br /> DESCRIPTION OF WORK:
<br /> AC V4 &tian ,
<br /> ASSOCIATED BUILDING PERMIT#(if applicable):
<br /> . MECH INICALPERMIT APPLICATION ',T,,,,,:,--,, -
<br /> z:.. x, PLUMBING,PERMITAPPLICATIO,N_r,"_,,., >. ,.
<br /> Type of Project: _New ” Addn Alteration _Repair Type of Project: _New Addn Alteration _Repair
<br /> #of List of Fixtures #of List of Fixtures #of Us!of Fixtures #of List of Fixtures
<br /> Fixtures Fixtures Fixtures Fixtures
<br /> A/C •Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg)
<br /> ed 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 lam 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 /> X3111 PERMIT#
<br /> ° . C M'to 11
<br /> 0 er/ ed Agent SIgnat Date (Revised 1 /12/2015)
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