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Apr 24 2018 01:31PM Washington Wateaters 8663757454 page= <br /> 016 PERMIT APPLICATION <br /> BUILDING I MECHANICAL/PLUMBING /SIGN !SPRINKLER I DE •LITTON <br /> CITY OF EVFRETT 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.everet(wa.gov/pe mits <br /> (Blue or BIac.k Ink Only Please) v� nPROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: a dt l D6 Y/ �� �PRCPERTY TAX 4: �(1q 11,2 1160Li GAL for new c0istruction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: r <br /> / TENANT NAME(If Commercial): <br /> OWNER MAILIN 3 ADDRESS: STREET a[Olq Ib& PI Su) j <br /> CRY GV {' <br /> I' STATE WO • L' 9g0+' 1 <br /> OWNER PHONE , 1-- I_ 1014, OWNER EMAIL: <br /> CONTRACTOR'IAME: V(//15f4( J6 17 ! i ii- /L1-16197-6C5- <br /> CONTRACTOR ADDRESS: STREET (7I j(�1..,�,�/�i f(, ,-rc 56- --- PO ,.6ox 5-,26g <br /> CiTY W l J 1 STME ttif4 2 . gO U 5O <br /> CONTRACTOR PHONE: '/2 - - L/f 7/ !CONTRACTOR EMAIL: (A14- f M6 @6 (t1 (O/? <br /> CONTRACTOR LICENSE#(REQUIRED): Wim* Bg6 P ICITY OF EVERETT BUSINESS LICENSE#(REOU±- D): 05 <br /> PRIMARY CONTACT: 0 OWNER COCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACTNAME• J 1 T CONTACT PHONE: (112 .- 'j_[j .'7/ <br /> . fI lJ t(- L s CONTACT EMAIL: (,lfj-I,y j U / &VI; <br /> BUILDING PERMIT APPLICATION <br /> Eniotin_ ;Jac:of 0 rilUlri_, . _ li __r Contract Price of Work:$ - <br /> Pro•osed Use of:uildin•: Heat Source: OGas /ectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family- of Units: ©Commercial ❑Industr <br /> Type of Project: New ❑Addition ❑Remodel ❑Repair 01-.1. ❑Sign ❑Sprinkler ❑Demolition ❑Change •f Use'i't //' A <br /> DESCRIPTION C.F WORK: ",--- <br /> RMci &pia& I „bit'it L u k �A t4-) <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATI 6 N ?) <br /> Type of Project: New— Addn Alteration Repair Type of Project: New _Addn _Alteration <br /> 1$of Li.f of Fixtures #of #of #of <br /> List of Fixtures List of Fixtures <br /> Fixtures Fixtures Fixtures t of Fixtures <br /> Fixtures <br /> NC-Ar Handling Units Heat Pump Toilet Backflow Pr:venter(Inside Bldg) <br /> Forced)Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basin) Drinking Fo . fair <br /> Water Heater Refrigeration i Shower <br /> Floor Drain <br /> Gas Fir-place 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 -lood / Water Heater Other: • <br /> Exhaus:Fan Sink(Service/Bar/Mopietc.) Other: <br /> • SPRINKLER I 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 per it 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 evthoriz din witting from the <br /> Building Official before being authorized under any circumstance,I em the owner,or lam authorized by the owner of this property to patrorm the work for hick application is made, <br /> and I comply with the State Contractors Law 18.27-4W and 296.200A WAC. <br /> City of Everett Officio Use Only <br /> m \ 1.1 i, <br /> jf Q ;t/ 11 <br /> 61-1 <br /> 1_ 7I PERMIT Ai <br /> Own r uthorized Agent Signature U \ 9• J <br /> Date (Revised 5l20/2016 <br /> ) <br />