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Oct 03 2018 12:57PM Washington Watters 8663757454 pag <br /> PERMIT APPLICATION <br /> BUILDING I MECHANICAL i PLUMBING /SIGN I SPRINKLER!DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 j FAX 425-257-8857 I(E)everetleps@everettwa.gov I www.everetiwa.govlpermits <br /> plus or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 5 .2,50 }^c)i/(/-LY 14V _. JPROPERTY TAX#:( 5 & 77 <br /> 0 i <br /> LEGAL for new construction: Short Plat/subdivision �� <br /> Lot No, (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME;ice ine41 jay �L TENANT NAME(If Commercial): <br /> V <br /> OWNER MAILING ADDRESS: STREET .6C) 1'._ <br /> rerncr /11)6 <br /> CITY STATE W 21p / ‹g..-.-C1)4 1 <br /> OWNER PHONE: .- La.. jS29 S 'OWNER EMAIL: <br /> CONTRACTOR NAME: i,0194/ 167T1 i w tel--I H cf)7 1 j • <br /> CONTRACTOR ADDRESS: STREET 015'Z Ulf 41- 4-rt — Po ,6Ux9926 k <br /> ern' R J V r 1 STATE thfZIP qk 51 <br /> CONTRACTOR PHONE: 4Z6-- ' -- g7I 'CONTRACTOR EMAIL: W -(,Jf- 'Y 6 CO60116 IL, army <br /> CONTRACTOR LICENSE#(REQUIRED): wj'-90-4-gsep 'CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 05 3 <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME' CONTACT PHONE: 6112- 1g3.-Ca7/ <br /> `\,/i(-[t/ Doni C Is CNTACT EMAIL: t t)10.'(4Jf/TCt f @ 6 01-4...(0)41 <br /> BUILDING PERMIT APPLICA'T'ION <br /> Existing Use of Building: Contract Price of Work:$ ..lip\l Ou <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type: I:SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units:__ „___ ❑Commercial ❑Industri lam" <br /> Type of Project: ONew °Addition CI Remodel ['Repair DTA. ❑Sign °Sprinkler ['Demolition ❑Change of Use <br /> C.DESCRIPT ON OF WORK: �� Ekci-nt f J <br /> iameL <br /> iL91°441-67/S) <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 __„Raga pppi <br /> # t9, <br /> of c�."`ff''�� <br /> Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Frxtur <br /> Fixtures Fixtures 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 /> Water Heater Refrigeration Shower Floor Drain ' <br /> Gas Fireplace Wood Stove Kitchen Sink&Disposal ,Grease Trap <br /> Gas Range Ducting DishwasherRoof Drains <br /> _ Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood ) Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> • SPRINKLER 1 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,stale,and focal law.The granting of a permit only authorizes approved worry and no deviations therefrom.Deviations must first be authorized in wriNne from the <br /> Building Official before being authorized under any circumstance.I am the owner,orf am authorized by the owner of this property to perform the work for which application is made. <br /> and 1 cornier),with the State Contractors La ci, f 16.27 RCWe .280.200A WAC. <br /> p /,l( len <br /> City orEverett Official Use Only/C'LS/L ; (0, 3--t PE IT# <br /> e Ipproass <br /> own /Authorized Agent Signature Date <br /> (Revised 5/20120161 <br />