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Jan 04 2019 02:54PM Washington Watts, I aters 8663757454 pag <br /> PERMIT APPLICATION <br /> affBUILDING 1 MECHANICALPLUMBING 1T SERVICES I DEMOLITION <br /> CITY OF <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 i(E)everetteps@evereltwa.gov I www.evorattwa.govtpermits <br /> SITE INFORMATION <br /> (Blue or Black Ink Only Please) PROJECTd � CO IAA XII <br /> � <br /> PROJECT SITE ADDRESS:)r D L far �ih1I A ` PROPERTY TAX#:O . .copy of long legal description) <br /> LEGAL for now construction: Short?Iatlsubdivlslon <br /> Lo[No._ (attach <br /> CONTACT INFORMATION <br /> TENANT NAME(If Commercial): <br /> OWNER NAME: .f.` ik - AS r <br /> OWNER MAILING ADDRESS: STREET a a • LA 1ia I A 1 zlP �/ /� <br /> 5 c O <br /> or, „,,,VG C. STATE <br /> A r1,_ 0 OWNER EMAIL: <br /> OWNER PHONE. ��fgc�t !•�7, }—��}'�2� �j <br /> CONTRACTOR NAME: WA-9.11��r , bfQ t � 6 6 !U}� y2,6 11 <br /> CONTRACTOR ADDRESS: STREET 111 2.. 1{I o W >4'tt � — <br /> eJ v/ t STATE teil f ZIP /, 4 <br /> CITY <br /> CONTRACTOR PHONE: ii 26--ig3- a CONTRACTOR EMAIL: , fa Ili <br /> -67 <br /> CONTRACTOR LICENSE#(REQUIRED): j i -qpc v!'/ CITY OF EVERETT BUSINESS LICENSEff(REQUIRED): 'T <br /> PRIMARY CONTACT: 0 OWNER P, ONTRACTOR 0 OTHER(Please Specify) <br /> ACT NAME• <br /> CON <br /> CONTACT PHONE: 2 -P-3 ,.— 7/ <br /> T <br /> 1 De �r'+r IS CONTACT EMAIL: telr'G11/ 4 <br /> er)���-jL,��I�Y! <br /> �J (�-� t BUILDING PERMIT APPLICATION <br /> Contract Price of Work:$ I k n . ------- k <br /> Existing Use of Buildln+: �� t 4_, i”. lectric ❑Other__ <br /> Proposed Use of� _ 11,M <br /> Adin•: Heat Source: OGas ❑Commercial l�lndu, � <br /> Buildin•Type:IT R-Detached DSFR-Attached ODuplex DMulti-Famil 4 of Units:__ MN <br /> T •e of Proect: New ❑Addition ❑Remodel ❑Repair ❑T.I. I]Sign ❑S•rinkler DDemotition ❑Chance of Use <br /> DESCRIPjj,ON OF WORK: WAleALlitlk <br /> t�Gt}„to160(i / �'l eal/) t <br /> S) <br /> ASSOCIATED BUILDING PERMIT#(if ap•licable: PLUMBING PERMIT APPLICATION <br /> MECHANICAL PERMIT APPLICATION Type of Project: New _Addn _Aftoration -_. ���� <br /> Type of Project: Rep�� <br /> New M Addn Alteration �Repair #of �'� <br /> #of #of List of Fixtures List of Ffxtur- <br /> #or List of F'xtures List of Fixtures Fixtures Fixtures <br /> Fixtures Fixtures Toilet Backflow Preventer(Inside Bid•) <br /> NC—Air Handling Units Heat Pump r Bathtub t <br /> H <br /> Unit Urinal <br /> eae <br /> Forced Air SystemsLaveto (Wash Basin) Drinkin• Fountain <br /> Gas Pipin• Boiler Floor Drain <br /> Refrigeration Shower <br /> Water Heater Range Ductin•Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas <br /> Gas FireplaceDishwasher Roof Drains <br /> Clothes Washer Medical Gas <br /> Clothes D er Hookups Other: Other:edic <br /> Water Heater <br /> Rangexhu t HoodaSink(Service/Bar/Mo./etc.) Other: <br /> Exhaust Fan <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Headspermit must comply <br /> ACKNOWLEDGEMENT.I have reviewed this application and confirm tho information contained herein is true and correct.Work done pursuant to this comply <br /> with made, <br /> work and no deviations therefrom. is perform t work app <br /> current Of ciat before local law.The <br /> granting <br /> any i circumstance.1 am flee owner,oapprovedr am authorized by the owner of this property ttto must first be work <br /> f for whichd In writing from the <br /> •ur'tdtnr� <br /> • •mpiy with the State Contractors Law 18.V ROW and ay ooA WAC. City of Enters Orricial Use Only <br /> n ` / j�fl PERMIT y�?� <br /> '" � Date (Revised 5/20/2016)0 •'i-'r)Authvrized Agent Signature <br />