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Nov 23 2018 09:55AM Washington In— Heaters 8663757454 11=-3 <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING /SIGN 1 SPRINKLER 1 DEMOLITION <br /> #41.114,7/----g <br /> / f y CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8610 I FAX 425-257-8857 I(E)everetteps©everettwa.gov I w✓rw.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:l V) al i n)a, PROPERTY TAX#:ate1i 0-0556DZOD <br /> LEGAL for new construction: Short Plat/subdivision r Lot No._ (attach copy of long legal description) <br /> /�, ,y CONTACT INFORMATION <br /> a' �' <br /> OWNER NAME -`G 1 ltd TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET II-11 1 tj 2¶r\`a, A �/� <br /> CITY l V e� 'f7 V� STATE LOA ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME W/t5OJ tiCl TI)N 4i-tit H T&$ <br /> CONTRACTOR ADDRESS: STREET f"71 2_ if bilk 14-rt 56' -- FF6SOX 592t? <br /> CITY R et t i tin STATE tilf3' ZIP 1 d U 5e <br /> CONTRACTOR PHONE: 42.6--g-g3— (07/ CONTRACTOR EMAIL: tJ f}•-L(J/9f VA( f 6/11611-4 (Cm <br /> CONTRACTOR LICENSE#(REQUIRED): 1,14¢"9 O tJ r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 5 3 ';4 <br /> PRIMARY CONTACT: ❑OWNER •CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT` pNAME• CONTACT PHONE: ci)2, --egg3 _y 71 <br /> s I KL I 06-41-e I S CONTACT EMAIL: (,(4'i 1/ f1(, a 61` I-. <br /> l� 1� C 00 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: StAe C4 •Contract Price of Work:sa I if I <br /> .,.. _ <br /> Proposed Use of Building: Heat Source: OGas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑industrial <br /> Type of Project: ONew ❑AdditIon ❑Remodel ❑Repair OT.I• OSign ❑Sprinkler ODemolition OChange of Use <br /> DESCRIPT ON OF WORK: <br /> i <br /> eA(40i"La--E.iple.a. 1 EieC/1/2 ,- W'f—ifLialfr(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 r e`F'r" '` <br /> Fixtures List of Fixtures FixturesLtsr of Fixtures #of List of Fixtures #°f List of Fixtur "'' <br /> Fixtures Fixtures <br /> ACC-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 FireplaceWood 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 J Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) . Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> !Number of Heads <br /> ACKNOWLLEDGEMENT 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,slate,and local law.The granting of a permit only authori as 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 th owner,ort 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 .27 PCW end 298.200A C. <br /> l f i City of Everett Official Use Only <br /> l <br /> ' iiPERMIT#f .—.1M tt l 1 001,6J <br /> wnerlAuthorized Agent Signature Date (Revised 5/20/2016) <br />