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Jul 18 2018 10:52AM Washington Water ers 8663757454 page T <br /> #14-1-7- PERMIT APPLICATION <br /> BUILDING/ MECHANICAL (PLUMBING /SIGN I SPRINKLER I 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.gov I www.everettwa.govlpermlts <br /> (Blue or Black Ink Only Piease) ( ( PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a4o 7` /1-1-E 'PROPERTY TAX#:lef1�t_10/V067 <br /> LEGAL for new constructio'i: Short Platlsubdiv sion Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 60ni. s) J-67212) TENANT NAME(If Corn.rnercial): <br /> OWNER MAILING ADDRESS: STREET -pi_ltf"'"f' <br /> cr r a--Qm-c, STATE1,..441 ZAP 9 c8 <br /> OWNER PHONE:Sith2}-tp93--16fbq )41 AL OWNER EMAIL: <br /> CONTRACTORNAME: Wr 5gIA'GiTb LU 41 .H67? 1?5 j� (,�.[��/jQ <br /> CONTRACTOR ADDRESS: STREET 11 t 5�,/�j i�VII "�i. - PO 19DX ✓!Gam'u <br /> c, (ti� id—c i STATE 'rJ ZIP C?kt)5d <br /> CONTRACTOR PHONE: 426-0-g3-- gel CONTRACTOR EMAIL: ,(j 'V L CZ6n4/4IL. (GPI <br /> CONTRACTOR LICENSE#(REQUIRED): r4. - ygriap CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 , rn <br /> PRIMARY CONTACT: ❑OWNER L ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME' CONTACT PHONE: <br /> C1l� -�0-C/g 7/ <br /> Ali / a +{ is CONTACT EMAIL: (,914- J , € � <br /> / l(,.Coyi <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building; Contract Price of Work:$ _ .. _ <br /> Proposed Use of Building: Heat Source: ❑Gas DElectric 0 Other <br /> Building Type: :ISM-Detached OSFR-Attached ❑Duplex ❑Multi-Family #of Units: ['Commercial ❑industrial <br /> Type of Project: DNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> iti/ric� ot--g-e i , / 0(65 G id ei Ill ) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New_ Addn Alteration ^Repel Type of Project: New , Addn _Alteration Repair r,_^ <br /> #of #of 4 o 4 o � ' <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures <br /> ANC-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 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(ServiceiBar1MopletcOther: <br /> • SPRINKLER I SUPPRESSION SYSTEM . <br /> 1Number of Heads i <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 witting from the <br /> Budding Official before being authorized under any circumstance,I am the owner,or 1 em authorized by the owner of this property to perform the work for which application is made, <br /> end I comply with the State Ccnlrectors Law 1827 RCW end 296 200A INAC. <br /> // City of Everett Official Use Only <br /> M <br /> 0 er/Authorized Agent Signature Date (Revised 5/20/2016) <br />