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Apr 24 2018 01:31 PM Washington Watleaters 8663757454 page <br /> • <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL!PLUMBING / SIGN/SPRINKLER I DEMOLITION <br /> ly7 CITY OF EVERETT PERMIT SERVICES <br /> ' ' 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257.8857 I(E)everettepsQeverettvra.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION jf[. t <br /> PROJECT SITE ADDRESS: I �C te�� PROPERTY TAX#: l 3SW CO <br /> LEGAL for now coistruction: Short Platfsubdivision Lot Na <br /> (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: fr//(/9 ) t 11W TENANT NAME(If Commercial): <br /> OWNER MAILIN 3 ADDRESS: STREETi7 /l�U ( id t <br /> CRY r/ t./Y-ep.'6 ,. STATE Iv* ZIP 47.5263 <br /> OWNER PHONE. L126-- 2.3S-90 OWNER EMAIL: <br /> CONTRACTOR NAME: MJ 5 I N6717.40 tki A}- IL He-14761U <br /> CONTRACTOR rADDRESS: STREET 1-115 L. (((B v.11.- het' 5.6 - P6 ,BV/X�JS926 k Q�i/ � <br /> cit [W'f ,V u! SSTATEbtfI+ ZIP 6 O U 5QJ <br /> CONTRACTOR PHONE: '/ZI -g-g-3- `/b 71 1CONTRACTOR EMAIL: t(i (,(,f VAC. C- 6/14./.9IL, (an <br /> CONTRACTOR LICENSE#;REQUIRED): t1.44-cJ -lo1otp 'CITY OF EVERETT BUSINESS UCENSE#(REQUIRED): 05 39 A5 <br /> PRIMARY CONT ACT: 0 OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT N <br /> AME' CONTACT PHONE: C/2 .gi3_ g 7/ <br /> V r/ D 1- s CONTACT EMAIL: W f/t-iL/` <br /> 6 L.tem <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of B,1ilding: QQ.Si d,Rhal Contract Price of Work:$ Litj251.�t <br /> Proposed Use of 3uilding: Heat Source: ❑Gas ❑Electric ❑Other _ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ORemodel 0 Repair DTI. OSign ❑Sprinkler ❑Demolition ❑Change of Use �Q(}+✓Q_ <br /> DESCRIPTION OF WORK: � <br /> Ems.l -.- ekto r V buccitir f'1_2 Id& <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 Lit of Fixtures #of #Of #of <br /> Fixtures Fixtures List of Fixtures Fixtures fist of Fixtures List of Fixtures <br /> 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 /> 1 Water Heater Refrigeration Shower Floor Drain - <br /> Gas Fipface _ Wood Steve Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range'food Water Heater Other: <br /> Exhaus:Fan _ Sink(Service/Bar/Mop/etc.) Other: <br /> • SPRINKLER!SUPPRESSION SYSTEM • <br /> ]Number of Heads <br /> ACKNOWLEDGEMEIVT: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,end local law.The granting of a permk only authorizes approved work and no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Official befor9 being authorized under any circumstance.I am the owner,or l 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 256.200A WAC. <br /> n City of Everett Official Use Only <br /> ` - -----) \ FERMI• # <br /> 1 .t0.4.....15-1 0 <br /> Own r/ uthorl3"e tent Signature Date � � � <br /> (Revised5/2!7/207&) <br />