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Apr 02 2019 02:40PM Washington Wal=-eaters 8663757454 pag(gires <br /> PERMIT APPLICATION <br /> BUILDING 1 MECHANICAL I PLUMBING 1 SIGN I SPRINKLER 1 DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> (Blue or Black Ink Only Pleas PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 3110 /3 ki yt-- PROPERTY TAX#:04 43se3240oov(.00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attactt copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME:,LA rd.!! 6 TENANT NAME(If Commercial): /J <br /> OWNER MAILING ADDRESS: STREET II 0 f.r`/� t Wig <br /> � ^j� 1 <br /> CITY .Y.e.4e ,IJ i- STATE Jyj/ig 5 qv 4�-! <br /> OWNER PHONE: L2-5-1(00- 5502 OWNER EMAIL: rr vv A <br /> CONTRACTOR NAME: w494 l tJ6Tb6-1 1,0 E/� f-i1T1j e <br /> CONTRACTOR ADDRESS: STREET /��I/ jZ���/�1164k- Ili . -- P6 box 692)k �jJ� jf <br /> oust p l,.! CiJ r✓l ! STATE /4 zip O U 5O <br /> CONTRACTOR PHONE: 42.6413- (A/7/ CONTRACTOR EMAIL: f t-f)j/J H VAC l4 6W(Lr (an <br /> n <br /> CONTRACTOR LICENSE#(REQUIRED): WrralS'idp CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 06 gyilei <br /> PRIMARY CONTACT: 0 OWNER I1.CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT/NAME�'•)J�}/� ! CONTACT PHONE: (I12 41:3_C/ '7/ II� , f <br /> \ A-( 1 2���-n 111-e l S CONTACT EMAIL: tiGi✓ I,3 /a/�f+r j��..r I6# V rL (O n <br /> UILDING PERMIT APPLICATION T <br /> Existing Use of Building: , gjcl.it,,,J7 Contract Price of Work:$ i O <br /> Proposed Use of Building: Heat Source: ❑Gas I jectric DOther <br /> Building Type: R-Detached ❑SFR-Attached ❑Duplex ❑Mufti-Family-#of Units: l ❑Commercial ❑Ind .r al <br /> Type of Project: ONew DAdd{tion ❑Remodel (Repair DT.I. OSign OSprinkler ©Domolition ©Change of ,se t' 1 '' <br /> DESCRiPT ON OF WORK: <br /> ti , <br /> 60k ` -Pjp/ a &ieCI- 1 G 1/0A-1(- 1--4'6 (S) <br /> 5 <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PEIKMYMI l APPLICATiON PLUMBING PERMIT APPLICATION <br /> Type of Project: _New— Addn Alteration ,•_,Repair Type or Project: New _Addn _Alteration Raga evic, " <br /> #of tistofFixtures #of •"`I'� - 7 <br /> Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtu f <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 /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Root Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood / Water Heater Other. <br /> Exhaust Fan Sink(ServicefBadMop/etc.) 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 and no deviations iherefrem.De4Iattons must first be authorized in writing from the <br /> Rnikhilo rtft7clal before being authorised undo,any araumatance,1. ho uwna,,u,lam author feed by the owner or this property to perform the wont for which application is made, <br /> and t comply wit Stale Contractors Law 1027 R • and 206.2. WAC. <br /> Ca./ Ili '' /iCty of Everett Official Ilse Only <br /> ( {f • 1 PET# � <br /> � ()LIniq , <br /> Owner/Authorized Agent&mature Date (Revised sed 0r2016) <br />