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JAN-25-2019 15:38 From:Arlington-�; tric 360+435+6970 To:4252578857 Page:1/11 <br /> PERMIT APPLICATION <br /> "lip. . <br /> BUILDING/MECHANICAL/PLUMBING/SIGN/SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 1 ` 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps©everettwe.gov I www.everettwa.gov/permits <br /> Blue.Oi Glad(Ink Only Plsaeo) . PROJECT SITE.INFORMATION. . <br /> PROJECT SITE ADDRESS: 1730 $ T PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> • ` . . ." CONTACT INFORMIs►TION • . . .. <br /> • <br /> OWNER NAME: C/72/7y &liths TENANT BUSINESS NAME(Commercial): _ <br /> OWNER MAILING ADDRESS: sTREEr /7.... 7 R4 5e- <br /> _..... <br /> p.� CITYG i- STATE ZIP / �z 03 <br /> 12 <br /> OWNER PHONE: ' S'~p / "lv OWNER EMAIL: WI c16,5 E ® frrni'%i. C tyV7 <br /> CONTRACTOR NAME: A{/inc a . 41'7s <br /> CONTRACTOR ADDRESS: STREET / /�ij eI �qp"3 f k) J <br /> CITY /TY -Ji ri r, STATE i�/r p ZIP pt2 Z '? <br /> CONTRACTOR PHONE: 360 Al o. —OS'-t5^ CONTRACTOR EMAIL: orb/72/pr 78y7 e e4rt t a''1 SN. /i <br /> CONTRACTOR LICENSE#(REQUIRED): ,4,01--/it)-e---'8✓a-36 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 32.yO5/ <br /> PRIMARY CONTACT: ❑OWNER 2tONTRACTOR ❑OTHER(Please Specify)_ <br /> CONTACT NAME: CONTACT PHONE: 360 A/03'-115"/S — <br /> �CtSS-c11 Tit—ran) CONTACT EMAIL: of-lrhyhy7, .,_4„„,„ Q, m5», torr+ <br /> • •• • • • ' :BUILDING INFORMATION' . .. • , ".'. •• , ,. ...,(f :.:•• . <br /> Existing Use of Building: Contract Price of Work:$ i i( Va vc- 357107 Oa ut.lir�t.730, CO <br /> Proposed Use of Building: Heat Source: ,[ as OElectric ❑Other <br /> BUtLDING USE:�SFR ❑Townhouse ❑Duplex DADU ❑Multi-Family-#Units: . ❑Commerclal ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair Li r.I. ❑Sign °Sprinkler ❑Demolition ❑Change of Use , <br /> DESCRIPTION OF WORK: /a/(ice yt,oa tVte-on/, <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ;' MECHANICAL PERMIT•APPLICATION,•••:;•••. ,' ' ..•“, '. . . PLUMBING PERMIT APPLICATION,;.• __. * <br /> Fix*" List of Fixtures F�lfh1 List of Fixtures Fixture List of PIxtures Fixture List of Fixtures <br /> Count count Count Count <br /> NC—Air Handling Units Gas Piping Backflow Prevanter(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-oomp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain _Sink-Utility,laundry,mop <br /> Exhaust FansResidential) Commercial Ventilatlor Floor Drain Toilet <br /> Exhaust Hood(Type i) (Not Heat/AC system) Hose Bibb Urinal <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems -Other Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> •, .'.,SPRINKLER•ISUPPRESSION SYSTEM :.• Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.ofFfeads <br /> Chemical Suppression System INo.of Heads <br /> ACKNOWLEDGEMENT;I have reviewed this application and confirm tho 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 tram 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 which application is made, <br /> and I comply with the State Contractors Law 18 W end 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#t\RD\ <br /> ....z./.„4......_ <br /> owns Authorized Agent Signature Date (Revised 10/10/2018) <br /> C:11--- ) <br />