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PERMIT APPLICATION mil <br /> I <br /> BUILDING/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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE ADDRESS: el-113 -pi, 5 E 1[02,CNe PROPERTY TAX#: 005 533 400 b '3t7°. <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> { Y r <br /> OWNER NAME: Gh ng-L.0 ri-c. M d A.iv TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET i.1% k'S eh. p' SG <br /> CITY -cv STATE WA- ZIP cf6 2t>e <br /> OWNER PHONE: i-(Z 5--zees-- q $Z OWNER EMAIL: <br /> CONTRACTOR NAME: ialJOVA-j'lvg.- Gow►f Z-'r 5z--1s-mviitS <br /> CONTRACTOR ADDRESS: STREET (1 5.--62_ bilit'A Arc LJ //' <br /> CITY /-4 JJ(J PO j /�STATE A— ZIP Igo 340 <br /> CONTRACTOR PHONE: 4'25— so, [ - -7__ 2 CONTRACTOR EMAIL: A- f c Cat 1l J.,mi ►c.©VIA <br /> CONTRACTOR LICENSE#(REQUIRED): N Ki CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: RUNNER IXONTRACTOR El•THER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: ig6>3g6), _2.5 vo <br /> AtJi —i `fes[,/A)f)LT CONTACT EMAIL: iarduk lc=�111 1k- .LOMA, <br /> „e : .... :. :•. � �.. BULD <br /> IING4PERM,,1 APELICATN�,./.IO . V,Y :� ...,. .. :, --_, ,.,f <br /> Existing Use of Building: Contract Price of Work:$ 38 <br /> Proposed Use of Building: Heat Source: I sxdas kElectric I irIther <br /> Building Type: RRFR-Detached I'4FR-Attached EL uplex IR ulti-Family-#of Units: I s d'ommercial lAndustrial <br /> Type of Project: IiiNew =F'ddition lill'emodel F'epair I6P4-.1. )4 ign `sF prinkler IThemolition Vhange of Use <br /> DESCRIPTION OF WORK: ik5,7 R}v r-4 "-1- PsrP <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> tiNtiMOKA-Si044:#0iimitAPPLICATION_ ..,`_..,., ; , .._,.« s. „., =PLUMBIN.G'PERMITAPPLICATION . ,. ., ,,tai <br /> Type of Project: _New _ Addn „Alteration Repair Type of Project: _New _Addn Alteration _Repair <br /> #of #of List of Fixtures List of Fixtures #of #of <br /> List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units 1 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 Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> Chemical or Water I No.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,state,and local law.The . ing 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 authorize. •-r 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 St- - ontract. - 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> �j' it /— �� Z�' PEFjjllllh# ( %O ` — (.O 2 <br /> It a � �� \v 1. <br /> O ner/Auth rize i Ag: t Signature Date (Revised 9/23/2016) <br />