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PERMIT APPLICATION <br /> /11Wi0Olb/ -.'"-ABUILDING I MECHANICAL/PLUMBING/SIGN I 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 Orr Black Ink;Only Please)° PROJECT SITE INFORMATION a <br /> PROJECT SITE ADDRESS: 72-4GaL j) Iv. PROPERTY TAX#: (c491 b 13 D bb/Du <br /> LEGAL for new construction: Short Plat/subdivision Lot No.____ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: )JV 61114 ..F=fllbV g <br /> TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET I DG ill VVA LT67) 15 Li P. --��}} ` ? <br /> crry 1/v STATE 1W/7 i' ZIP 1Cy 1. ,V .7 <br /> OWNER PHONE: Z.bb"SI 17 Ole 1 OWNER EMAIL: di t).5-I;el bo) 11-49 r"$Z'a 3 014; l/ . c Ont <br /> CONTRACTOR NAME: fr Id l) <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR I THER(Please Specify) kg-641 lit-Pr <br /> CONTACT NAME: CONTACT PHONE: 2.04 74 3-- 3, <br /> CONTACT EMAIL: pq I e R r al o a boil 1564 CO <br /> BUILDING PERMIT APPLICATION f <br /> Existing Use of Building: '5 1 N (se LEI Pj°rW11 Li Contract Price of Work:$ ofYi.5, dad <br /> Proposed Use of Building: a 51 n 61 r n lj'L Heat Source: ❑Gas ]Electric ❑ er <br /> Building Type: 31(SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Co ercial El Industrial <br /> Type of Project: ❑New 'Addition $Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑De IoM n ❑Change of Use <br /> DESCRIPTION OF WORK: 6,p 8'vfsl' 0...i,, gsp Lj-S tj *„e 70 L)vl NFrFtizen. <br /> 4 Itav t-��r' P32:04 P l�'TD Lt v) w-e-fr> -f ft• ft-PD ivy <br /> c. 4 -O Nv 1 ., �- 471 o0 e L eV- $1.17 Mi 4 1')-i• p- 'wsv a Nos �(x11'�l A6-' <br /> A WC k D BUILD(NOlRMIT# If ap ble): geY'oDPl'1... 0-,.Y SnvemGNr . ATI.3 <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 #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC-Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater J Bathtub Urinal <br /> Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration I Shower Floor Drain <br /> Gas Fireplace Wood Stove ) Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting i Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: J Clothes Washer Medical Gas <br /> I* Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER/SUPPRESSION SYSTEM <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 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.lam the owner,or lam 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 /> T# City ooff Everett/reOfficial(UseeOnly <br /> 1 PE,f, MIT# 1 [>J2 `�OL1 <br /> At�' �z- z • �e�g <br /> Owner/Authorized Agent Sigspaire Date (Revised 9/23/2016) <br />