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4-77. PERMIT APPLICATION <br /> BUILDING / MECHANICAL / PLUMBING / SIGN I SPRINKLER / DEMOLITION <br /> CITY OF EVERETT 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.everettwa.govipermits <br /> 1(Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: L."' 'S 1 S}m _Sit-J}Y t,%0z'1-- (...-9 7 PROPERTY TAX#:C(J(z.2.`, 3,:,;( 2.2, 3cJf-i?cs <br /> LEGAL for new construction: Short Plat/subdivision Lo;No (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: IX5 e 1(i'V1" L s.i„i,-, ',tt,t,t. TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: (H 5 7 s I--L, >'4- ,.c.,ry (.Jvnr F C..- r1 7 <br /> OWNER PHONE: (- ,)5- 3 c-/ c7 5 O j OWNER EMAIL: <br /> CONTRACTOR NAME. 't,'L--, /3(0-L-tivc/Ckr`{i.:j <br /> CONTRACTOR ADDRESS: s- -- I )7)2c'. I I (rd"GZ k.1-e---- U^._ <br /> .,-. i y^`t r,./"(,"") STATE LA. V71/— C(..j'2- 3 <br /> CONTRACTOR PHONE: (•'-t-t ) - (-+( * -c'l 5-(-/S- CONTRACTOR EMAIL: ,(4LL113("4N..t-%L`V-k� {"_,9 j ii/Vii : c_iAH <br /> CONTRACTOR LICENSE#;REQUIRED):/Vu(I i3C ) ei_. 65.5 Pii° ;CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 7( ;�Li <br /> PRIMARY CONTACT: f l OWNER D CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4.--) :") - 9 Cy _ Ct.-Gz L_ - <br /> 1 Ri et i--c. (c.&. ''1' &/`L^J' CONTACT EMAIL: /jit )3- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: S_ Pu-::, <br /> Proposed Use of Building: Heat Source: ❑Gas , l'Electric DOther <br /> Building Type: ❑SFR-Detached DSFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercal 0 Industrial I <br /> Type of Project: ❑Nevti ❑Addition DRemodel DRepair ❑T.I. OSign DSprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: <br /> Per) cc- O J(:A.-i 6----,./...c...00 .0 1,,,fi L✓,:L.' -./..-.0./c. c.. ,, t- L___ <br /> ASSOCIATED BUILDING PERMIT#(if applicableir <br /> I MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn Alteration __Repair Type of Project: New _Addn _Alteration _Repair <br /> of List of Fixtures #of List of Fixtures of List of Fixtures "of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> AC-Air Handling Units Heat Pump Toilet Backflo..Preventer(Inside Bldg, <br /> 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 I Sink(Service/Bar/Mop/etc.) Other. <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical or Water INo.of Heads <br /> ACKNOWLEDGEMENT:I have reviewed this application and confirm the information contained herein is irue 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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 18,27 RCW and 296 200A WAG_ <br /> ) (-g--1 c. p mr 4( City of Everett Official Use On y <br />