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Dec 26 2018 02:14PM Washington Watr-'aters 8663757454 peg= <br /> PERMIT APPLICATION <br /> #1,/ /"--111 <br /> BUILDING/MECHANICAL!PLUMBING /SIGN!SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 88201 <br /> (P)425-257-8810 I FAX 425-257.8857 1(E)evereileps@evereltwa.gov 1 ww✓v.everettwa.gov/permit <br /> (Bute or Black Ink Only Please) PROJECT SiTE INFORMATION <br /> PROJECT SiTE ADDRESS: ' NI 1'11-1' <br /> •/arty* Lt,i4 qa rPROPERTY TAX II: if 1 / C O <br /> LEGALfor new construction: 5hottPEatlsubdivision 4 �� 1 <br /> Lot No. (attach copy of tong legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: MIIII Uri <br /> 'L., TENANT NAME(if Commercial <br /> OWNER MAILING ADDRESS: srameT / <br /> OWNER PHONE: ~ � <br /> OWNER EMAIL: <br /> CONTRACTOR NAME: W4514 IAj(J}' N A 'f4-TFL 1-4 -1971-6-14.5 <br /> G .Tj <br /> CONTRACTOR ADDRESS; 17(5Z_ if `� �9F-"/} <br /> STREET ,i ��t.._ � "' '6 %V� •/a <br /> CRY '51Litfil W 1 <br /> CONTRACTOR PHONE: 2`j— 2._ STATE ZAP e <br /> • CONTRACTOR EMAIL: �f • <br /> CONTRACTOR LICENSE 1tf{REQUtREo: p` 1 '� �` !j z� a �� }�Y� <br /> } W -' .7 I- DtI t r i <br /> PRIMARY CONTACT: ❑OWNER it CONTRACTOR 0 OTHER(Please SpecifTY y) <br /> EVERETT BUSINESS LICENSE#(REQUIRED): f/y/,~ <br /> CONTACT NAME;_._ <br /> p fy) <br /> l f� CONTACT PHONE: `2- -g:'373-c/S 7/ <br /> j CONTACT EMAiL: GtI#-Wig-kiG { a@ 6( L.(e141 <br /> _ :h iLDING PERMIT APPLICATION <br /> Existin. Use of Building: a s II�''I Paas <br /> Contract Price of .ark:$ r 1110 <br /> Proposed Use of Building: � <br /> Buitdin• Type: QSFR-petached C1SFR-Attached Heat Source: r4K1.,g ❑Electric ❑Other <br /> ❑Du.lex ._.,.__riar�. <br /> Ty.e of Project: ONew Addition ClRemodel ❑Re•air CIMulh Famil 4 of Units: ❑Cornmercfal Otndustrial <br /> DESCRIPTION OF WORK: ©T•1• �Sf.n ❑5•rinkier ©Demaiition C1Chante of Use <br /> ge.gnNAL —-el ed""L' 1 <br /> 0(65 4a04r-Al beeej <br /> ASSOCIATED 9URE71NG PERMIT#(ii a•plicabie. <br /> MECHANICAL PERMIT APPLICATION Age PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn <br /> ___Alteration _._Repai ,# <br /> #of f.A TYPe of Project: New Addn Alteration Re f!! ._ <br /> Fixtures , 111 <br /> List of Fixtures #of #of pair_ <br /> Fixtures List of Fixtures list of Fixtures #of ....�'' <br /> ME AIC-Air Handlln•Units _ Fixtures Fixtures Um of Fixtures <br /> M.Forced Air Systems _ MI Balet 11111111 Backflow Preventer(Inside Bldg) <br /> "' MI Bathtub <br /> 111.11111=12: 111111111 Soifer Lavatory(Wash Basin) <br /> 1111111 Refri•eration Floor <br /> Fountain <br /> Gas Fireplace Shower Floor Drain <br /> Wood Stove MN Kitchen Sink&Disposal <br /> IIIIIIIII munimiaminum moi Ductin. MOM Dishwasher <br /> Clothes Dryer Haoku.s Other: _Roof Drains <br /> __Ran Hood Clothes Washer menMedical Gas <br /> �� Sink Service/Bar/Mo./etc. Other: <br /> Other: <br /> SPRINKLER/SUPPRESSION SYSTEM <br /> 11111111.11....Number of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is true and Correct. Work do pursuant to this��� <br /> ACKN federal,state,and lace/fay. The praising of a permit authorizes a <br /> h <br /> Building Official before being authorized under any circumstance.I am the owner,ori am authorized by the owner of this property to perform the work for permit <br /> applicatmust ion iswmade, <br /> oproved work end no deviations therefrom.Deviations must first be authorized in writing from the <br /> and 1 comply with the State Contractors Law 18.27 ROW 240.200.4 WAC. <br /> City of Everett Official Use Only <br /> ,� "— I r7, 7/'_-1 PERMIT <br /> Own,Authorized Agent Signature a �'�r C � <br /> Date (Revised 5/2012016) <br />