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Jan 04 2019 02:54PM Washington Wat_ aters 8663757454 pag <br /> PERMIT APPLICATION <br /> 4E77BUILDING I MECHANICAL I PLUMBING/ SIGN I SPRINKLER f DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 i FAX 425-257-8857 ((E)everetleps@everettwa.gov j www.everettwa.gavlpermits <br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:`"1l ii, eL PROPERTY TAX#:001(.019 0 1110 i s <br /> LEGAL for new construction: Short Plat/subdivision __Lot No. (attach copy of long legal description) <br /> r CONTACT INFORMATION <br /> OWNER NAME:Ge('1rci6 's-eve:,+.S , -it.)-) <br /> NAME(if Commercial): <br /> OWNER MAILING ADDRES : STREET Ln -i' 7 LJt ziPCI � <br /> clry Vexc—tt STATE <br /> OWNER PHONE:44Ct,O f ID-9/D( OWNER EMAIL-: <br /> CONTRACTOR NAME: Wf t'(1 N'G7 ► UN VV - HC-4/7-61?-_-.5 <br /> �� <br /> CONTRACTOR ADDRESS: smear 1112— E t tf G ll- i -v: 'f" - P6 O)ax <br /> S-92-6 <br /> 2-6 a 7f� <br /> ,,// f cn. f_4(11-041 <br /> ✓/ I STATE Ola4. ZIP gp�/r/ 5C.J <br /> V <br /> CONTRACTOR PHONE: Z6-gg3-- (V 71 'CONTRACTOR EMAIL: UMW/9*k" -L &)60,16 I LI (U�f! <br /> CONTRACTOR LICENSE#(REQUIRED): G *9 1T "giOr ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Qs?Vi Y"'"J <br /> PRIMARY CONTACT: 0 OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME• CONTACT PHONE: (04.-gg3`Cg 7/ <br /> UK(' Diii - Is CONTACT EMAIL: talo#WA-ffZ iK__O(/WiL.( V"/ <br /> ,1 �- 1 1C�'_{� BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: T,S)L 4SL. Contract Price of ork:$ 16 V,O <br /> Proposed Use a 1.51 : <br /> Heat Source: ❑Electric • er .,,�,,,-_._,,jR/ <br /> �.� Oco ciat Din stria( t <br /> Building Type: FR-Detached ❑SFR-Attached ODuplex ❑MUltl^Family-#of nits: � hon e of � <br /> 011‘ <br /> Type of Project ONew DAddition ORemodel ❑Repair OT.I. OSign OSprinkler ❑Demolition g ✓�/ <br /> DESCRIPTION OF WORK: , „� ..e-b11-0-146-e- <br /> / 'C-• f G a5 o (,/tel/• ' <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION ( PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn Alteration __Regal Type of Project: __New Adds _Alteration _Repair .r1%M" <br /> #of #of #ofLtst of FiAYures #of List of Fixtures <br /> List of Fixtures Fixtures List of Fixtures Fixtures Fixtures <br /> FixturesBackflow Preventer(Inside Bldg) <br /> AIC—Air Handling Units Heat Pump Toilet <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> y Lavatory(Wash Basin) Drinking Fountain <br /> •Gas Piping Boiler "~ <br /> I. Water Heater Refrigeraticn :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 /> W Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> • SPRINKLER I SUPPRESSION SYSTEM <br /> ` !Number of Heacs <br /> ACKNOWLEDGEMENT.t 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 fecal law.The granting ofa permit only authorizes approved work and no deviations therefrom.Deviations must first be authorized In writingorom n is maga, <br /> he <br /> suuvtno Official before being authorised under: circumstance.I am.he owner,orf am authorized by the owner of this property to perform the work for which app <br /> and f comply with lbs State Contractors Law I a 0 <br /> RC W and 294.200P WAG. City of CEverett Official Use Only <br /> 90.e,( + I <br /> ll(--c <br /> - � i [PERMIy\ - DX/ - <br /> OwneriAufhorized Agent Signature Date (Revised 5r201206) <br />