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• <br /> PERMIT APPLICATIONBUILDING/MECHANICAL/PLUMBING/SIGN I SPRINKLER/DEMOLITION <br /> (.7. 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 /> (Blue or Black Ink Only,Please) . PROJECT SITE INFORMATION •• - <br /> .___J <br /> PROJECT SITE ADDRESS: 9 �� PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat(subdivision Lot No. (attach copy of long legal description) <br /> . . ..CONTACT INFORMATION . . . <br /> OWNER NAME: Wee. 360 (,L G TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET (70J V/0. ST S"TE- A_i . <br /> MY fcW'7 STATE ari ZIP ?8a77 <br /> OWNER PHONE: I4,�,cp tf OWNER EMAIL: . ra/t�iok-WecireefriS LC^ r r <br /> CONTRACTOR NAME: E "(�a( AJ 6 Tia-Ter t'-(C P 4,67A-c.- <br /> CONTRACTOR ADDRESS: STREET '24'2,-0 PAC,1 AU g <br /> • <br /> CITY SUCV2451T STATE tAi A— ZIP 1 2120 <br /> CONTRACTOR PHONE: 4 S5.2 c 2.>31 Kt • CONTRACTOR EMAiL: ilt#tv'�'Z @ 4E5571414.4. ei, <br /> CONTRACTOR LiCENSE#(REQUIRED): E( Q2.4.5s 422.2,0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): &a 6o 55- <br /> PRIMARY CONTACT: ❑OWNER IaCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4 75e.2-5'2-WO <br /> 0'1M r' r CONTACT EMAIL: eQ4$ <br /> .i <br /> BUILDING PEIT APPLICATION • <br /> • <br /> Existing Use of Building: t) i4e_ OFPc(A" 1 Contract Price of Work:$ /34 06 <br /> Proposed Use of Building: 1s/? e 70t V Heat Source: iaGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached CISFR-Attached ❑Duplex ❑Multi-Family-#of Units: El-Commercial ❑Industrial <br /> Type of Project: ❑New DAddition IQ£2emodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 2cw©ves pp(01-C6 51-074 D-To . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> fOCI Aid!CAL,1PER111IIT APPLICATI®M . . . PLUMBING PERli/ilT APPLICATION i <br /> Type of Project: New Addn Alteration )e-Repair Type of Project: New Addn Alteration _Repair <br /> #of List of Fixtures #of List of Fixtures #°f List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> I 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 /> :.&iiRilkig(LEk i 4)4,10PR.EPMci.ti SYSTEM . <br /> Number of Heads <br /> ACKNOWLEDGEMENT:l 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/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 /> r 2/5// 2( IV C g00 OO <br /> Avpaer6Authorized 4Signature Date (Revised 5/20/2016) . <br /> I <br />