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PERMIT APPLICAT10111111 <br /> BUILDINCHANICAL/ PLUMBING/SIGNRINKLER/ 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 1 www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: /2//ebEP6rfAvE.,t. PROPERTY TAX#:ljj}y,39/�// 0A62.0 <br /> LEGAL for new construction: Short <br /> t Plat/subdivision Lot No. (attach copy of long legal description) <br /> S f;y,5' �P."�' S.a'S�' ... 5 �w�' 9 <br /> wb <br /> OWNER NAME: Ri/OA/4404 Ct.4 VD TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /6 <br /> /V 77/ (S'7" se,u <br /> /J <br /> CITY �/4. LIZ STATE /,U' ZIP 9�Q /Z <br /> OWNER PHONE: 4'25 1/ -/9ZZ OWNER EMAIL: if—hog d/a y�i^D(am t/& a D/• <br /> CONTRACTOR NAME: £2) 7Z( //.Q/vpY/LIAA// &7 $/GG/A//ry5 <br /> CONTRACTOR ADDRESS: STREET PO E.'c'k Z5-5-6-S <br /> CITY � /V / STATE //4/.7 ZIP 98/ .5- <br /> CONTRACTOR PHONE(2O ) ;S9-/3, v'73 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED) C• y • U�7 / #( <br /> CITY OF EVERETT BUSINESS LICENSE REQUIR ):,D/7r <br /> Ari. .. <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR ,"OTHER(Please Specify) P65/4A DZ <br /> CONTACT NAME:�4„ ,e/47(7 Zed// CONTACT PHONE: ' )85-6-932-3 <br /> CONTACT EMAIL: "„<a ,•&p k"z.,6jy)aC &R• O 144 <br /> 51 441 01040 Irl 1 1) 0-iK Ailakq <,^ <br /> Existing Use of Building: Res/D / 7'/4L -SWALEAWationtract Price of Work:$ 750/3 <br /> Proposed Use of Building: Re-5/&eiv 7/A L smib r.A140 Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type:)FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition J21<emodel El Repair DTA. El Sign El Sprinkler CI Demolition El Change of Use <br /> DESCRIPTION OF WORK: RE/WOVC/4$/1>E,1)60/ l'AffiL , GVALCKEA77 6/)(f"xi$E7. ,e/L(Q(/o [t)40us <br /> pl s 77 GC'E,Ar G/v/66/D/N/,Vc, W6,4 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL"P.E,RMIT APPLICATION, <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn Alteration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Figur s 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 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 /> l ies#0100 0.9.4.0: E S$,1OS Yz 0101 li <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 with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 9'/Z ` PERRu Oci S _. <br /> Owner/Authorized Agent Signatu Date l/ (Revised 5/20/2016 <br />