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Nur <br /> PERMIT APPLICATION <br /> #111111°""A BUILDING/ MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink,Only;Please) I,I ;PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /120 Y6i '741., " p,/ PROPERTY TAX#: OO1�9/68/v.100 <br /> LEGAL for new construction: Short Plat/subdivision 'V•flt 4 ,8L c5tLot No.—TJ (attach copy of long legal description) <br /> =CONTACT INFORMATION <br /> OWNER NAME: Hai /#41 877,4y 61-.07 ','41i1 TENANT NAME(If Commercial): 701+(L ',,/ 23',ari <br /> OWNER MAILING ADDRESS: STREET /3 %o 3 95 f-r (f27. t',•/. <br /> CITY Milit f . tee) STATE ZIP 93 z.7 S <br /> OWNER PHONE: /� OWNER EMAIL: <br /> -71CONTRACTOR NAME: . j7. ,. jU'�101 Lew). <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: /y <br /> CONTRACTOR LICENSE#(REQUIRED): ficiAI 3 1'0 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): /9/ 5--b <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR AOT <br /> HER(Please Specify) 11.4461/ <br /> CONTACT NAME: 7 et d 4'4-Clr/rec.rej4 CONTACT PHONE: ('4i) af 2. . 2/S <br /> J' CJArAjet',to ly CONTACT EMAIL: ra ,/ t 7J/2 - '/ c4 ..C <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: /C r-.40, / Q,. 6C.0 Contract Price of Work:$ OS' <br /> Proposed Use of Building: a 4?/ /2.e7i7t,. Heat Source: l Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,ommercial El Industrial <br /> Type of Project: El New ❑Addition Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,- /07Pit04, <br /> ? — 4-'t .i� <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICALPERMIT`APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 /> rya SPRINKLER I SUPPRESSION;SYSTEM441 <br /> Chemical or Water I No.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 /> 22$ <br /> �t� PF2M� /��/r G <br /> Owner/ thorized Agent Signature Date <br /> (Revised 9/23/2016) N <br />