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PERMIT APPLICATION <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN/SPRINKL P ''91TIQly� <br /> "111410 . <br /> CITY OF EVERETT PERMIT SERVICES 1 ISI H I. <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 /> ,,,kh-, , Ar, PROJECT SII INFORMiA ON i3'2 . .,I L i faZts,' <br /> PROJECT SITE ADDRESS:go-4 1 ai,{) / PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision { Lot No. (attach copy of long legal description) <br /> _ :`'f� IvSti/i <br /> ' CONTACT INFORMATIOI OWNER NAME: � �- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET C6 n /� �yp� [ <br /> h CITY /V V J STA1F! V 1 ZIP g ��/` <br /> OWNER PHONE: 30 b -- 2.-c---C p D ‘ill....-- OWNER EMAIL: V' 1 CA <br /> CONTRACTOR NAME: I l LA, 7 L L ,per <br /> CONTRACTOR ADDRESS: STREET -1 I I CO 2_,2/0' �� t-'-) ' -/ <br /> CITY LIT STATE V . A— ZIP 9 CSS <br /> CONTRACTOR PHONE: -c \ ( 79 �COnNT,RACTOR EMAIL: IM 61 <br /> CONTRACTOR LICENSE#(REQUIRED) 1E 6 �'- `/Q. [CITY OF EVERETT BUSINESS LICENSE#(REQUIRED)P �,0 <br /> , „" gym_, """ . <br /> ., �_ .� ,_ .� ten,.. _� � r� a� <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CON-A T NAME: _ CONTACT PHONE: l le (. 1t.3 61 <br /> AJ J\JU1.A (Z/ CONTACT EMAIL: In i 61 <br /> k ;Y,w;at;' r = rel' BUILDI P RM T,APPLICATION� ,r li - x,` <br /> " � _ ��;��. ��,; � �,�.� � , a .,� ����Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ylectric ❑Other <br /> Building Type: ❑SFR-Detached SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project:,Vew DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler CI Demolition OChange of Use <br /> DESCRIPTION OF WORK: <br /> 51 °ilk-) 7/(31At 014A-C,HL rc t 71-S-1---A ( ( <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> yip_ `4 1MlEC IANIACAL PERMIT iyi,'y 1,,, PLUMBING„1PERMIT APPLICATION i t"r,r. <br /> Type of Project:,New _ Addn _Alteration _Repair Type of Project: _New Addn _Alteration _Repair <br /> #of #°f List of Fixtures List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures 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 /> ,, 'T'spRINKLEit t SUPPRESSION SYSTEIVI ry'.'', <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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 VSOSOS - O <br /> Owner/Auth• ' ed Agent Signat e Date (Revised 10/12/2015) <br />