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BUILDING , `CHANICAL I PLUMBING I SIGN/SPRINKLER 1 utmuLi I IMV <br /> , ' � CITY OF EVERETT PERMIT SERVICES <br /> h►' .y 3200 CEDAR STREET,EVERETT,WA 982t <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 Please) PROJECT SITE INFORMATION <br /> PROPERTY TAX#: .r 0 0 —.. <br /> PROJECT SITE ADDRESS: _. 11-1,-r4 . Lot No._ (attach copy of long legal description) <br /> LEGAL for new construction: Shod Platisubdivlsicng <br /> CONTACT INFORMATION <br /> t Pa T4 in ..LL,CrENANT NAME(If Commercial): /wpm- Home-- <br /> OWNER NAME: �f I'��U +� <br /> OWNER MAILING ADDRESS: STREET 744'2 s.% 2-1 C(�s ' cuter (�{�/� <br /> 1.6 <br /> cny .C,R..tr I S f�"J STATE ZIP !r.° ".� <br /> lib <br /> OWNER PHONE: 4/2-C"' ' f - Z•� j�OWNER EMAIL: <br /> /( (/ <br /> • �� X ` L.K L s MVM" Y <br /> CONTRACTOR NAME: �^F�'11�9c�✓�-- .,�,.�,�,( <br /> CONTRACTOR ADDRESS: STREET 7'42•(0 '6"` ',;Q t-. S t' <br /> CITY MI L 5 STATE tk..,)f ZIP q o <br /> la <br /> CONTRACTOR PHONE: q"LS"` 2413 i—(0 t"UpCONTRACTOR EMAIL: (th,QQ rrie1[(Q$MA.'f(Atti,/3WI (CITY OF EVERETT BU ESS LICENSE#(REQUIRED) � ,'� �` <br /> CONTRACTOR LICENSE#(REQUIRED): � •'� "'_i <br /> PRIMARY CONTACT: 0 OWNER iitCONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: T 2s-- (- (9 2(d CONTACT EMAIL: rod(.. Ad I .coY <br /> 'fv) <br /> BUILDING PERMIT APPLICATION <br /> Contract Price of Work:$ IS-1 000 <br /> Existing Use of Building: <br /> Proposed Use of Building: Heat Source: OGas DElectric °Other <br /> Building Type: CISFR-Detached DSFR-Attached ODuplex ❑Multi-Family-#of Units: <br /> ❑Commercial ❑Industrial <br /> Type of Project: ❑New DAddition ❑Remodel DRepair OT.I. ❑Sign °Sprinkler ❑Demolition °Change of Use <br /> DESCRIPTION OF WORK: 1�5�-A-L-t.Ff o?3 c Niz� M�u� � <br /> e X t Sz ‘�Cq Les, - t LA-rio be Pc. fl- V t u (LE-P uortA IJ� MAN` <br /> vJR5 MoJd oL� Dis-) 0 $ AnALL_ £ Li ci'°S <br /> ASSOCIATED BUILDING PERMIT# if a.•Ilcable: PLUMBING PERMIT APPLICATION <br /> MECHANICAL.PERMIT APPLICATION <br /> Type of Project: ,_.,_,New __Addn __Alteration __Repair <br /> Type of Project: __„_New Addn ___Alteration __Repair yp j #d <br /> #of List of Fixtures List of Fixtures <br /> #of List of Fixtures List of Fixtures Fixtures _ Fixtures <br /> Fixtures Fixtures Backflow Preventer(Inside Bldg) <br /> Heat Pump Toilet <br /> A/C-Air Handlin Units Bathtub Urinal <br /> Forced Air S stems Unit Heater Drinking Fountain <br /> Boiler Lavatory(Wash Basin) <br /> Gas Pi.in. <br /> Water Heater Refri• Shower Floor Drain eration Grease <br /> Gas Fire•lace Wood Stove Kitchen.Sink&Disposal Roof a Trap <br /> Ducting Dishwasher , <br /> Gass <br /> Range Clothes Washer Medical Gas <br /> Clothes Dryer Hookups Other:' <br /> Range Hood Water Heater Other:, <br /> Sink(Service/Bar/Mop/etc.) Other: <br /> Exhaust Fart <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> Chemical or Water No.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the <br /> with <br /> information <br /> herein <br /> irue and <br /> oWork <br /> done <br /> pursuanto this <br /> pmcply <br /> currentfederal,state,and local laIThe granting of a permit only authorizes approved work and deviations therefrom.Deoon first e authorized in writing the <br /> Building Official before being authorized underany circumstance.!am the <br /> owner,or 1 am authorized by the owner of this property to perform the work for which application Is made, <br /> and!comply with the State Contractors Law 18.27 RCIN and 298.200A WAC. City of Everett Official Use Only <br /> 1 if L_____,0 <br /> PERMIT frli JP <br /> +� <br /> Owner •uthorized Agent Signet e <br /> Date (Revised 9/23/2016) <br />