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Apr 24 2018 01:44PM Washington Wal=rneaters 8663757454 pag=1 <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL I PLUMBING I SIGN I SPRINKLER 1 DEMOLITION <br /> 10 -414/"--a CITY OF EVERETT PERMIT SERVICES <br /> J .xx., 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov( www.everetlwa.govfpermits <br /> (Blue or ala•k Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE •DDRESS: I Lij 1 49/ 1,,e_se l ,�W✓ <br /> PROPERTY TAX 4: 0/OW. t <br /> LEGAL for new c• structicn: Short Plat/subdivision Lot No. (attach copy of tong legal description) <br /> CONTACT INFORMATION 1 <br /> OWNER NAME: Hgu9..ell, P LQn �,,.,,��//,� TENANT NAME(If Commercial): <br /> OWNER MAILIN ADDRESS: STREET Iii t l�•J=y 01 Sri <br /> env 910 h0-141tiSh STATE kill ZIP ,6 <br /> OWNER PHONE f20 if—116-itil/O OWNER EMAIL: es, . <br /> CONTRACTOR AME: Mf f{4f-t/ . 6/761 14-1-612,_ H T f1 5 <br /> CONTRACTOR ' DDRESS: STREET 1-1 I Z ti lir - IVC.. 5 -- Pb <br /> hog 6926k <br /> r f / crry R-e4v L U1�1 STATE (.ylf ZIP T h156' <br /> CONTRACTOR•HONE: `126-i$3— g'-7/ CONTRACTOR EMAIL: IAA-WA-ft OM. 60144(1.4 (OM <br /> CONTRACTOR ICENSE#(REQUIRED) thin lOort!( ,CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 0 5 c9 9z <br /> PRIMARY CONT•CT: ❑OWNERCOCONTRACTOR D OTHER(Please Specify) <br /> CONT� (AjCT'�NAM:• CONTACT PHONE: T -gip-clic 7/ <br /> �rz`�— t—( IS CONTACT EMAIL: liiJl��rtf �}t++/�� f L (Oki <br /> PERMIT APPLICATION <br /> Existing Use of Building: <br /> cisi Q "' Contract Price of rk:$ ' �19ZA) <br /> Pr000sed Use ofilding: Heat Source: DElectric DottierBuilding Type: FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair CIT.'. ❑Sign ['Sprinkler ❑Demolition ❑Change of Use It <br /> DESCRIPTION OF WORK: <br /> Piell4 0 111/4"e_ gi' RePlate / g642,/ 60a474,-Ittv <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION 10 PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn ,_ Alteration _Repei Type of Project: New , Addn Alteration __Repair <br /> #of #of #of #of <br /> List of FixturesList of Fixtures List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—Mr Handling Units— Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pil ing Boller 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 Mood Water Heater Other: <br /> Exhaus:Fan Sink(Service/Bar/Mop/etc.)4 Other: <br /> SPRINKLER)SUPPRESSION SYSTEM <br /> j Number of Heads <br /> ACKNOWLEDGEMENT.'I have reviewed this application end 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 ciruimst ce.f 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 a 296.200A WAC. <br /> i f // City of Everett Official Use Only <br /> i l / t r-.77- PERMITp/1/� ISO 4 O1 / <br /> I erIA uthorized,agent Signature Date 4U[ {Revised 5/220/2tV 0116) U C// <br />