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PERMIT APPLICATION <br /> BUILDING i MECHANICAL I PLUMBING 1 SIGN 1 SPRINKLER 1 DEMOLITION • <br /> AVCITY OF EVERETT PERMIT SERVICES <br /> ` 3200 CEDAR STREET,EVERETT,WA 98201 <br /> ._: , (P)426-257-8810 f FAX 425-257-8857 1(E)everetteps@everettwa.gov f www.everettwa.gov/permIts <br /> PROJECT SITE ADDRESS: .5I j 0 0 bVi /? S . !PROPERTY TAX##: <br /> LEGAL for new construction: Short Piat/subdivision Lot No, (attach copy of long legal description) <br /> - . ' ..cot TAl e'iiklIFOAMAT1''NI . •• • • • • • • . <br /> OWNER NAME: {DtAAL 4 131 TENANTrNAME(If Commercial): — ^ --- <br /> OWNER MAILING ADDRESS: sTRear 15i I (� OVt,2 , I • <br /> cm' LU L%2 STATE 'Lt/('} . ZIP 'I ezbJ <br /> OWNER PHONE: (42,61C) i -- /9 7 7 IOWNER EMAIL: <br /> CONTRACTOR NAME: C UCIR.C4-M4 51�Ter $2 -c- <br /> CONTRACTOR ADDRESS: sTaser -I2- (A .l u gr - <br /> ' <br /> ar, V r i STATE 141 4— ZIP 61 S326/ <br /> CONTRACTOR PHONE: 4°2.5.-2 2.,I-6/I ti • 'CONTRACTOR EMAIL: /< /-1 0 ‘2S'511'74t , cowl <br /> CONTRACTOR LICENSE~#(REQUIRED): E(,2 5 002,2,0 1." ICITY OF EVERETT BUSINESS LICENSE#(REQUIRED): &6,1 5- <br /> PRIMARY CONTACT: 0 OWNER j .CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ) CONTACT PHONE: Li7 5-2-5'2_'>//9 <br /> I ► - ....o CONTACT EMAIL: <br /> • -' ' i3Oli.tiNG.p Kith`. PP,LitAT1(oN ' . , <br /> v^ v <br /> Existing Use of Building: i Contract Price of Work:$ )IR). <br /> Proposed Use of. tiding: Heat Source: Gas )]Electric ❑Other <br /> Building Type: OFR-Detached °SFR AttachedDuplex °Multi-Family-##of Units: °Commercial ❑industrial <br /> Type of Project: °New °Addition CfRemodei Repair DT.I, °Sign ❑Sprinkler °Demolition ❑Change of Use <br /> _ FfDESCRIPTION OP WORK: ReIJ(a6 q 0 O`er 6f6 5 Fe,e/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> .: : :M C1t4, ,NIC.AI,•PERNMIT APPLICATtai I I . • • . PLUMii;ING PBRIVl1T APPILYC.ATIO0 <br /> Type of Project: _New. Addn Alteration 'Repair i j Type of Project: New Addn Alteration Repair I <br /> •°f List of Fixtures ` °f Llst of Fixtures ' °f List of Fixtures °f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units Heat Pump Toilet Backflow Preventer(Inside Bldg) <br /> I 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 Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> '. :•6riXii iSYKILEC&,i1PPRESS1C'•Nf sygnivii ' <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,state,and locallaw.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.l am the owner,ori am authorized by the owner of this property to perform the work for which application is made, <br /> i.03 <br /> and I comply with the State Contractors Law 18,27 RCW d 296,200A WAC. <br /> CityofEverett Official Use Only <br /> e:::::.' �� PERMIT � ail ^� j <br /> owner/Authorized gent Signature 3-- ZS- i y <br /> Date ---] <br /> (Revised 6/20/2018) <br /> I <br />