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Jul 18 2018 10:54AM Washington Water li—iters 8663757454 page <br /> 4:77PERMIT APPLICATION <br /> BUILDING f MECHANICAL I PLUMBING I SIGN/SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <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.govfpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 'C3e' Mk/ Agit #-2Z PROPERTY TAX#: <br /> LEGAL for new construction: Short Platlsubdivision_ Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: c r til-JO 5, bouf.(,ept. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 13 6r/ /14Jt y pt.. �2, <br /> cmTYQ�`ti _ ! STATE "v/`r ZIP 9 <br /> sze <br /> OWNER PHONE:Zljt,---/r3-71 61OWNER EMAIL: . <br /> •CONTRACTOR NAME: (AJ 5t-ti 10(71-7-61Q LA)f-11--M a <br /> HC---/476-k5- <br /> CONTRACTOR <br /> Ht T ? <br /> CONTRACTOR ADDRESS: STREET I11Z (1 ,kill- ti-rt 56 — 16 Lox 9172.6k <br /> en-rye `: v(/ STATE ll' ZIP gg/)fQl <br /> CONTRACTOR PHONE: 42.6 ( '7/ CONTRACTOR EMAIL: loci-jffitt 69-6 C 60414.11., CCM ,J� <br /> CONTRACTOR LICENSE#(REQUIRED): lal- al iA CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05 gite- _ <br /> PRIMARY CONTACT: D OWNER [.CONTRACTOR D OTHER(Please Specify) <br /> CONTACT NAME' �{ N/ I CONTACT PHONE: 44g3-T 7/ <br /> . i <Q DLJ i l-i S CONTACT EMAIL: W'tj-kfff-Hl+iiic@ 6 irimiw,£CJ'vI <br /> D <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 1 c a Contract Price of Work:4/8 <br /> Proposed Use of Building: Heat Source: DGas ectric DOther <br /> Building Type: Mgar ❑SFR-Attached ❑Duplex ❑Multi-Farnily4 of Units: _ ❑Comrnercial pin. <br /> INF <br /> Type of Project: Ili'ew DAddition ❑Remodel ❑Repair UT.I. ❑Sign ©Sprinkler ❑Demolition ❑Change of se I l i4 <br /> DESCRIPT ON OF WORK: W/(11/1/41°( <br /> 9 <br /> 6vook,e_ Qt-Eepfrizt 1 &le c/i/i c <br /> 11(Y/S--) <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 Rep ©pO` <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixture ��--'"ff'' <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 /> i <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 l SUPPRESSION SYSTEM <br /> )Number of Heads <br /> ACKNOWLEDGEMENT.I have reviewed this application end 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!am authorized by the owner of this property to perform the work for vrhich application is made, <br /> end i comply with the State Contractors Law 117.27 RC and 290200A WAC. <br /> City of Everett Official Use Only <br /> 4111C~ d. <br /> i / t <br /> f�f ((-1-17-g''' PERMITS^ EvG�O 2........ ock 3 <br /> Own-rlAuthorized Agent Signature Date (Revised 5/20/2016) <br />