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41-17 PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN /SPRINKLER / DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: ' tuq /�� ` 3I>�ROPERTY TAX#: 06.3('1,(Y,`1O0 /07 O'er! <br /> LEGAL for new construction: Short Plat/subdivision ! lJ7 �i Lot No. (attach copy of longnglegal description)ciptiion [ / <br /> CONTACT INFORMATION <br /> OWNER NAME:$17-�",�) JO® `` TENANT NAME(If Commercial): <br /> •OWNER MAILING ADDRESS: STREET aq 74 � CJ f < 'L <br /> CITY -eSTATE Wit lit ZIP a 3 <br /> OWNER PHONE: �1Z5 7O"057c---- OWNER EMAIL: l L�P ')/H""RVVV�nn�`VAV0® ' (8k1 <br /> CONTRACTOR NAME 0 �-e plor l/ W j <br /> CONTRACTOR ADDRESS: STREET 1 i -770 4" l $i s'( o 41 <br /> r ////���� <br /> CITY I �0u i K_ aevYaa STATEzIP qr�(') )a <br /> CONTRACTOR PHONE: 1-1�9- 7 1 ._ CJ CONTRACTOR EMAIL: f(J ir�� vi, <br /> 1 �- �� YI'1� ��' C��a �� � <br /> CONTRACTOR LICENSE#(REQUIRED):311)lam t H8Y5-1(-4a CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):Qh-7-7U o <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER (Please Specify) go <br /> CONTACT NME: CONTACT PHONE: ,-11i,j. -` -11 / - ''761 <br /> MAO\ CONTACT EMAIL: jn6,) ( i.e1:1(2 erim `/V� �,7,t ,„ <br /> \\XPOIP BUILDING PERMIT APPLICATION <br /> `` /f�A. <br /> Existing Use of Building: Contract Price of Work:$ `—( UQ ova <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric ❑Other <br /> Building Type: CFR-Detached OSFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ONew DAddition 0 Remodel epair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use _ <br /> DESCRIPTION OF WORK: <br /> \*\ 01V61Y-46 <br /> Paila Cliaa aa— as heal pP ' 3 a/l <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 Repair <br /> #of <br /> Fixtures li List of Fixtures Fixtures List of Fixtures Fixtures j List of Fixtures Fixtures List of Fixtures <br /> A/C—Air Handling Units I Heat Pump ,Toilet _Backflow Preventer(Inside Bldg) <br /> t 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 /> SPRINKLER/ 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,state,and local law.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.I am the owner,or lam authorized by the owner of this property to perform the work for which application is made, <br /> a d I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 11 City of Everett Official Use Only <br /> 111 <br /> , , / All,"/- i . 1/i 6 PERMIT# <br /> (4 0 1-. h <br /> Ow .,1 orize�►,ge i at e / Date (Revised 10 12/2015) <br /> 1 <br />