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IIII II II PERMIT APPLICATIOM <br /> "Illfr*,,,,%/—_, A BUILDINL+MECHANICAL/ 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT// SITE INFORMATION <br /> PROJECT SITE ADDRESS: 66 Q south 20V 4V El b(,fc'r-1 t• PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r,u f f to Co fl 1 nas TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 006120 2 C ov ill 2 0V <br /> CITY v(rt,+-1.-- V STATE Loa*/* ZIP C -D�/ <br /> 1,8 3 <br /> OWNER PHONE: LI 2 ' 'Z3 C ^ cj t4 j,`� OWNER EMAIL: 3 3 0 c f r`�Qhvrl, 4 K. co PI <br /> CONTRACTOR NAME: At I l l (Di,v /11 tO'i,� 1 ' <br /> CONTRACTOR ADDRESS: STREET 1 ® C,e-i 1-c." v./ Iti p^ <br /> CITY Ti l`Lit/ I Gr STATE IV, - ZIP �, V t �� <br /> CONTRACTOR PHONE: 2o( - 9Q 3 1 ,.6©' r <br /> 7 CONTRACTOR EMAIL: V Gt�1 1,„-- fa 4q..9 P /ry „Ct oi <br /> CONTRACTOR LICENSE#(REQUIRED): At Lf pp 1 cc, P 4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): Y ) <br /> PRIMARY CONTACT: 0 OWNER g•CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ZO 1.l, 61-3 CI 4 6 , ` 7 <br /> I"G'( 1n Crr 4 C'e CONTACT EMAIL:--t .k t. r Q ( G lil nu IM Vii)r ' _G®�► <br /> BUILDING PERMIT APPLICATION ,f <br /> Existing Use of Building: Contract Price of Work:$ 1?) r5"."2K•n LIC).. <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New DAddition DRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler DDemolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 11VV of f\14/rh, a l lAtj 1 Yvuo 'b kvice i h <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 Repair <br /> #of List of Fixtures #°f List of Fixtures #°f List of Fixtures #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C-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 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 24. Other: "-ki PJ6` ihtx /r') <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.)/Mop/etc.) Other: t - r 1"I A e f <br /> y / <br /> Of 4// Ln5lJ t• ac• IAA ....e., <br /> SPRINKLER/SUPPRESSION SYSTEM 2G` d('A•,n t t,n is 1,4,,c)0_ <br /> Chemical or Water ' No.of Heads ® 'f.-h p t'ly. <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,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 I 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 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> M /z ce(f r PERMIV#W.,19 <br /> -- (3k,g6 <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) <br />