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Sep 06 2018 08:50AM Washington Watttaters 8663757454 page'' <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN !SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (F')425-257-8810 I FAX 425-257-8857 1(E)everetleps@evereltwa.gov I ww+w.everetlwa.govipermits <br /> (Blue or Black Ink Only(Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: L t'5Z leli t 1-1-H -'P 31Y (PROPERTY TAX#;6CfY02 O(/&f/oO <br /> LEGAL for new construction: Short Plat/subdivision Lot No,__ (attach copy or long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: IC 21 ZL (-nria G TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET ? 2' C L `j`'(^ 5 6 <br /> • <br /> CITY ~if"V' 'I',/ STATE I,L'r hZIP q s' 2 6S' <br /> OWNER PHONE: -7 20 5<43(--( fi ? OWNER EMAIL: -...--` <br /> CONTRACTOR NAME: UJif51(1Ilwn jl.) W,6l2_ H6-747-6-its- <br /> CONTRACTOR <br /> �•'7"Ts <br /> CONTRACTOR ADDRESS: STREET !"71 5 Z t((,tat" ,1--rc 5 — P6 13DX 6926g <br /> CITY f7end-tri STATE t/ilA` ZIP qh 5X <br /> CONTRACTOR PHONE: 426 --K3- / '7/ �yCONTRACTOR EMAIL: t (jfl-feV,9i, 6f�,J�I(,,z `C <br /> CONTRACTOR LICENSE#(REQUIRED): W '(L(•-yZ!e CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): p 5 ciMi <br /> PRIMARY CONTACT: 0 OWNER C .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAM y, p CONTACT PHONE: C1'„L�.g _(/' <br /> g3 `7 j <br /> `-"'(C VO'4l 4 IS CONTACT EMAIL: W (bekii`Hc@64 L,Om f <br /> , <br /> BUILDING PERMIT APPLICATION <br /> rl f , ( <br /> Existing Use of Building: 1( .J S1.C,441 air <br /> Contract Price of Work: 1_UJ <br /> Proposed Use of Building: Heat Source: ❑Gas ectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex 1(ulti-Family-#of Units: i ❑Commercial ❑industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair DTI. ❑SIgn ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCR!PTON�OF WORK: <br /> � �jf %/e �f1 ��/} / WiLl6ff17--ktita7(S) <br /> �/' ' L" / L �'ll �lWu' il�C. C7 Y ! C• <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 _Repa <br /> #of List of Fixtures #of <br /> xtures <br /> Fixtures Fixtures List of Fixtures Fixtures L#ofist of Fixtures Fixtures List of F(xturr-� <br /> - <br /> NC—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 f Water Heater Other: <br /> Exhaust Fan Sink{Service/Bar/Mop/etc.) Other: <br /> SPRINKLER!SUPPRESSION SYSTEM <br /> Number of Heads <br /> , <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the Intotmation contained herein Is true and correct Work done pursuant fo 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> id l comply with the State Contractor Law 15.Z r ROW and 290.200A WAC. <br /> /� <br /> G'ty of Everett Official Use Only <br /> 9 <br /> {� tet qtP Ef.,itk OR BOO <br /> Owner/Autharized Agent Signature Date (Revised 5/20,2018) <br />