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Jul 18 2018 10:53AM Washington Water I r—ters 8663757454 page <br /> girPERMIT APPLICATION <br /> BUILDING/MECHANICAL I 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.gav I www.everettwa_govipermits <br /> (Blue or Black Ink Only Please) PROJECT SiTE INFORMATION <br /> PROJECT SITE ADDRESS: /Ci I Vilreit Pt 4 -t PROPERTY TAX#: 114ciao 3k,t1, 11 <br /> LEGAL for new construct cn: Short PlaUsubdivision Lot No. (attach copy of long legal description) <br /> /� CONTACT INFORMATION <br /> COWNER NAME: 61 600)/0) ii ( 1.... //TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET! $Z1 Y J ripI A / <br /> CITY 611-elrjtC STATE tf`' zw <br /> OWNER PHONE:L.l 1(,tY }1(441 OWNER EMAIL: <br /> CONTRACTOR NAME: 1,06/41 ti6iTU (ti i?-Tr l2- ,r�-� �j — <br /> CONTRACTOR ADDRESS: STREET i�?I S��Z/.��/�11 t0 i4V t 5 — P "`0X � (! <br /> ,( �+ <br /> cry 'PAV yr 1 STATE � ZIP gf/ 5U <br /> CONTRACTOR PHONE: 426-iE3- tit ry` CONTRACTOR EMAIL: W 04-Ll t_"'6.1nil�IL (ern <br /> CONTRACTOR LICENSE#(REQUIRED): MI- 4 j f2 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 66(9V <br /> ell <br /> PRIMARY CONTACT: ID OWNER L CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME' CONTACT PHONE: (1Z - 3' -/S''7/ <br /> Jict i Da-n I-(Is CONTACT EMAIL: ‘,4,414-444-11, )1JC' 6 inhi1C-•(Cm <br /> BUILDING PERMIT APPLICATION <br /> Existirg Use of Building: Contract Price of Work:$ _ _ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric Other <br /> Building Type: DSFR-Detached ❑SFR-Attached ODuplex ©Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project ❑New UAddition 0 Remodel DRepair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> e4fricIA-L real' - 1 (s 6U d 'Aia ) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATIONPLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _ Repel 6i <br /> Type of Project: Naw _Addn _Alteration Repair ittiorl,r , <br /> #of List of Fixtures #of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures_ <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preuenter(Inside Bldg) <br /> • Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> t 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(ServiceiBar/Mop(etc.) .Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads _ <br /> ACKNOWLEDGEMENT.-f.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 focal law.The granting ore 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,ort am authorized by the owner of this property to perform the work for wh!ch application is made. <br /> end I with the State Contractors Law 10.27 RCW a .t?86.200.4 WAC. <br /> City of Everett Official Use Only <br /> li 7:t6.-/K <br /> n PERMIT 9.... 04 <br /> i i <br /> 0 rlAuthorized Agent Signature Date (Revised 5/20/2016) <br />