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/1/20/7 <br /> PERMIT APPLICATION <br /> j'IP*/..&."—/—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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: not C 1.1,48 de !/Ie t, DR._ PROPERTY TAX#:cot/3 Sg 32 2g oc, I coo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: JZj/IJAC li, 44y7oA.1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET /7 3/ lot"417.4 ISI/ <br /> CITY IyN b7W00/ STATE L6 ZIP Oj7 <br /> 2 <br /> OWNER PHONE: . q2O 4 !!!///��`I9 OWNER EMAIL: // 4 ,. e���✓ ivi"i/( <br /> CONTRACTOR NAME: By 0W''/ J&(Z- <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: IkOWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: a0G ei,20 429 /1011, <br /> jj <br /> b OA/ L4Yr0 it CONTACT EMAIL: Wei��y ® ni/10 1,Vr 4011 <br /> BUILDING PERMIT APPLICATION / <br /> Existing Use of Building: ?.-eteo c/ .sv. Z �� Contract Price of Work:$ %O f�Q, <br /> Proposed Use of Building: Res:e€0,,,6%, / S.F.''‘.-2,C9.-i7 Heat Source: ili2Gas SElectric ❑Other <br /> Building Type: $ISFR-Detached ❑SFR-Attached °❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition IgiRemodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> Add W 68 PB i►-ren-� Ws", spice 040 //(1;i lg 5,/ ,46. • eu.ed i*. )(g. ' nix <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 List of Fixtures #of List of Fixtures #of 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 /> SPRINKLER/SUPPRESSION SYSTEM <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 Officialbefore 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 OOnly <br /> 4r e ��� PERMIT# 9) IA)h I_7 f `J4 <br /> Owner/Authod ent Signature to (Revised 9/23/2016) <br />