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Dec 26 2018 02:14PM Washington Wataters 8663757454 pag(A <br /> (4:677. PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING I SIGN 1 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 j(E)everetleps@everettwa,gov j www.everettwa.gov/permits <br /> (Bine or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: tpo l 1�- "C PROPERTY TAX#: (J 'f 3OOcf(J3 cc - <br /> '5 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION j) , <br /> OWNER NAME: JC v' , Zah rte, TENANT NAME(If Commercial): J�v/J(! <br /> OWNER MAILING ADDRESS: STREET 5641(}�.�/�/f `�`�' �ffj� <br /> cm', Wl<r/WtJI STATE (A Jif ZIP q8' -L' .3 <br /> OWNER PHONE: 7-0 Ce ``122 1 52 OWNER EMAIL: ,---- <br /> CONTRACTOR NAME: Wif5tilAJOrrbfQ !j(J 14-Tti1 1-16676-1(45 <br /> CONTRACTOR ADDRESS: STREET I""71 I5 Z C((i --V f 56 — Po ES! <br /> ox Gr�b' <br /> CITY R 1.� L ,i tJ <br /> STATE "fZIP 5O <br /> CONTRACTOR PHONE: 42_64g3- qff7/ CONTRACTOR EMAIL: W (,6/9-f/169-‘ f�61j (Lr (Cr/4 <br /> CONTRACTOR LICENSE#(REQUIRED): W* 'gde •-rr CITY OF EVERETT BUSINESS LICENSE#{REQUIRED): 05 39'9 <br /> PRIMARY CONTACT: ©OWNER C)LCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME' 1 r CONTACT PHONE: t/24,183-C/ 71 <br /> ` f (`-'�-r NAME,,. <br /> j1 (5 CONTACT EMAIL: 0041-,tligWt HC_@ 6 al1411-.£CO) .. <br /> BUI ING PERMIT APPLICATION +� <br /> Existing Use of Building: / (;j <br /> L ,4t re oContract Pricork:$_ 1;10 0 <br /> Proposed Use of Building: Heat Source: s ©Electric ❑Other <br /> Building Type: °SFR-Detached ©SFR-Attached °Duplex OMuItI-Family-#of Units: °Commercial ❑Ind rial \ <br /> Type of Project: °New °Addition DRernodel ❑Repair DTI. °Sign °Sprinkler ❑Demolition °Change of U k_frff&,P.W1/4h-' <br /> DESCRIPTION OF WORK: he .` r-" <br /> g`�e. Yl�r`L tt=-e�1 - j (u b(Ja. di <br /> ASSOCIATED <br /> BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION ,nr ' PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration _-_,Repel ' 1� Type of Project: _,_New _Atfdn _Alteration Repair r,�-;(;: <br /> #of � <br /> Fixtures LlStof Fixtures FixturQS List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 Water Heate 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(ServiceiBarlMopfetc,)I Other: <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> [Number of Heads - <br /> ACKNOWLEDGEMENT: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,stale,and local law.The granting of a permit only authorizes ap, : :.work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official before being authorized under any circumstance.tam the own am authorized by the owner of this property to perform the work for which application is made, <br /> anrj.t • •ly with me state Contractors Law 18.27 RCISI end 296.200A V/AC. <br /> • <br /> tCtly of Everett Official Use Only <br /> f.- ••' A1AW ()./61 i .fI t ri. PER T ,-i <br /> ' <br /> Owl•uthorized Agent Signature Date (Revised 5/20/2016) <br />