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Jan 23 2018 12:24PM Washington Watelfters 8663757454 page r <br /> 477PERMIT APPLICATION <br /> BUILDING I MECHANICAL I PLUMBING I SIGN I SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8510 I FAX 425-257-8857 I(E)everettepe c©everettwa,gov I vwaw.everettwa.gov/permite <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> i4 <br /> PROJECT SITE ADDRESS: q( Zt&Dr W PROPERTY TAX MOO R, 6000000ol(J <br /> LEGAL for new construction: Short Plat/subdivision Lot No.__ (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f"1 V&n Y VL I,I TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET �4z/4/Liog tU -W <br /> CITY eA LJ-"' STATE /4 zip 9 0:3 <br /> OWNER PHONE: C°/�5-37&h2/$g OWNER EMAIL: iii <br /> CONTRACTOR NAME: WA-501&)1iT?J W A- i2G—fl —6-4U <br /> CONTRACTOR ADDRESS: STREET 1.115 2- <br /> 111, j4-get — Po 460x 6126 k <br /> ``�� / cr, !til�F L�7 �1r 1 STATEbil ZIP gk50 <br /> Z' - <br /> CONTRACTOR PHONE: / S3- `J'71 CONTRACTOR EMAIL: (,JJ--AM*VAC 461/g( -z Car) <br /> CONTRACTOR LICENSE#(REQUIRED): W#1- -kat t/ f CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER I2ONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME CONTACT PHONE: q2. rj—C�i 7/V ( D1'iifS CNTACT EMAIL: �.(1f.�'IiUl 'i�L -l1/ Cly L..CQm <br /> BUI DING PERMIT APPLICATION <br /> Existing Use of Building: RI Q7 Contract Price of k:$ i 1 00 <br /> Proposed Use of Bolding: Heat Source: OElectrfc ❑Other <br /> Building Type: R-Detached ❑SFR-Attached ODuplex ©Multi-Family-#of Units: ❑Commercial ustri <br /> 'Sipe of Project: New ClAddition DRemodel DRepair OT.I. ❑Sign ©Sprinkler DDemolition DChange f Use <br /> DESCRIPTION OF WORK: :__.___----) <br /> kivvium 4., eip/c -a - r cj wa.4 <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 /> it of List of Fixtures #of <br /> List of Fixtures Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> Fixtures <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 /> — <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(ServicedBar/Mopletc,) Other: <br /> • SPRINKLER/SUPPRESSION SYSTEM <br /> !Number 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,slate,and local law.The granting of a permit only authorizes approved work arid no deviations therefrom.Deviations must first be authorized in writing from the <br /> Building Oficial before being authorized under any circumstance.I am the owner,or!am authorized by the owner of this property to perform the work for which application is made, <br /> and i comply with the State Convectors Lew 1027 RC nd 298.20011 WAC. <br /> City of Everett Official Use Only <br /> CmWt1 <br /> 1 r 23'/ Cu PER <br /> ig'15' O�� <br /> verlAuthor9zed Agent Signature Dale <br /> {Revised 5/202016) <br />