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Feb 15 2018 08:42AM Washington Water liters 8663757454 pagt1 <br /> PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING / SIGN i SPRINKLER / DEMOLITION <br /> #.1111111111CITY OF EVERETT PERMIT SERVICES <br /> iiivai: <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 I(E)everetteps@everelwa.gov evere:twa.gov I www.everettwa.govlpermits <br /> (Blue or Black ink Only Please) PROJECT SITE INFORMATION • <br /> PROJECT SITE ADDRESS: 4/010 IQ- et./ /1-4-C1PROPERTY TAX#: 'O6li ' 9OO 5( () <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: i oQgcl Int TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 0 F ge�� *r- <br /> CITY V STATS w - ZIP gag) <br /> OWNER PHONE: (-1-2. -1%--- 177 OWNER EMAIL: --- <br /> CONTRACTOR NAME: Ui/1 1 f iE)6rr UJ,'1 E,Z_ �-19:76i $ <br /> CONTRACTOR ADDRESS: STREET I-70 I• Mewl- tl-(/'t! 5 -- 86 ,BGX�/ Y2i)g <br /> Cn'f p'e j�, 7 1 STAT'_ (/✓ l+ LP 9S1)5g <br /> CONTRACTOR PHONE: 4z6-'g - "71 CONTRACTOR EMAIL: 0_,,M4.01-ii/6-6.Y/A6. 6filI(Lti in <br /> CONTRACTOR LICENSE#(REQUIRED): Wi4-9-jialgti#2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 06 3VT-/ <br /> PRIMARY CONTACT: ❑ OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT <br /> OONTAv''' c ACCT/NAME• CONTACT PHONE: �'Z .Eg3-(a`7`/ <br /> / DA-fit-els - CONTACT EMAiL: Li'Jf-fit/f� /1-i`-� 6 <br /> ,0 '*JL.(O1'v <br /> i BUILDING PERMIT APPLICATION <br /> r" <br /> Existing Use of Building: I Mir-14.1. Contract Price of k:$ rji/ <br /> Proposed Use of Building: Heat Source: Ga CDElectric ❑Other <br /> Building Type: ❑SFR•Detached C R-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ID New E:1 Addition C❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _Repair Type of Project: _., New -,•,_.Addn _Alteration _Repair <br /> #of List of Fixtures #of #of <br /> Fixtures Fixtures List of Fixtures Fixtures List of Fixtures List of Fixtures <br /> 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 /> • SPRINKLER/ SUPPRESSION 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 crcumstence./a• e owner.or I am authorized by the owner of this properly to perform the work for which application is made, <br /> with the State Contractors Law 18.27 RCW and 296,2,. AC. <br /> •comply <br /> City of Everett Official Use Only <br /> CW, ���� PERMIT. "10 — <br /> lneriAuthorized Agent Signature Date (Revised 5/20/2016) <br />