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4.77 PERMIT APPLICATIM i. <br /> BUILDINmmAECHANICAL/ PLUMBING /SIGIU UPRINKLER/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 1 www.everettwa.gov/permits <br /> ;(BMus or Black Ink Only*easel PROJECT.SITE INFORMATION K <br /> PROJECT SITE ADDRESS: Ziit `l' >' 4,-re-4. )pp PROPERTY TAX#: Gt4?q ttp7-4o I7& <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> ' CONTACT INFORMATION, <br /> OWNER NAME: 1\1 I" \/ e V TL j Ute(' TENANT BUSINESS NAME(Commercial): <br /> OWNER MAILING ADDRESS: STREET 71C( 'ISR . 1J <br /> CITY . J tta<<1 STATE lasr. ZIP 1 e,z0 <br /> OWNER PHONE: 4i .5' , • oc3S0 OWNER EMAIL: Ina 10aLlic.k.1 ° Co tM1ga+ . (01/Y)CONTRACTOR NAME: CPOJ <br /> CONTRACTOR ADDRESS: STREET I cloor .good '/tu AY J Si n- ...Qc Q <br /> CITY s ''L• I S STATE INA. ZIP 915 fLD <br /> CONTRACTOR PHONE: "22(Q• eiCD3, (D'l t CONTRACTOR EMAIL: c"rt74.pNrir- /� C pvil In 1,0 . (per <br /> CONTRACTOR LICENSE#(REQUIRED): C.0M�►� icy-71A CITY OF EVERETT BUSINESS LICENSEI.' #(REQUIRED): at 1' Pi <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 51-OTHER(Please Specify) Atittlittletc <br /> CONTACT NAME: CONTACT PHONE: pa* L 1I1, <br /> CJI f CONTACT EMAIL: P'i/1�'iS e -�� <br /> ,3 Yh x ,x BI ILDIMR I FOR.rrIon . <br /> Existing Use of Building: cove. (o-n t4,,, OcrAt,F -1--A.4161_, Contract Price of Work:$ —7.2")i Dom_ <br /> Proposed Use of Building: Cr..totick..__ o jr 13A)67_, Heat Source: %Gas ❑Electric ❑Other <br /> BUILDING USE: ❑SFR ❑Townhouse ❑Duplex ❑ADU ❑Multi-Family-#Units: Commercial ❑Accessory Structure <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair VT.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> -I61p.4L-f' I Wica ui r--. EY fli4 `1.1001- '1 <br /> ' t �-4leo O <br /> c- ' Vg x-.ni‘ irrvrtE -ia..LA14. c ,t)$. r uT ,tt_ 0414iits . <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> ,. `MECHANICAL= 'ERMIT APPLICATIONPLUMBING.PERMIT:A P,LIRATION .... ,,,'`' <br /> Fixture Fixture Fixture Fixture <br /> Count List of Fixtures Count List of Fixtures Count List of Fixtures Count List of Fixtures <br /> NC—Air Handling Units Gas Piping Backflow Preventer(Inside Bldg) Shower,Tub,or Combo <br /> Boiler Gas Range Clothes Washer Sink-Commercial(3-comp,prep,floor) <br /> Clothes Dryer Heat Pump&Ductless Dishwasher Sink-Residential(kitchen,bath,bar) <br /> Duct System(Remodel) Refrigeration Drinking Fountain Sink-Utility,laundry,mop <br /> Exhaust Fans(Residential) Commercial Ventilatior Floor Drain Toilet <br /> Exhaust Hood(Type I) (Not Heat/AC system) Hose Bibb _Urinal _ <br /> Exhaust Hood(Type II) Water Heater Interceptor-Grease Waste/Water Piping Repair <br /> Exhaust Hood(Residential) Wood Stove Interceptor-Sand/Oil Water Service(behind meter) <br /> Forced Air Systems Other: Medical Gas Water Valves or Fixtures <br /> Gas Fireplace/Insert/Log Roof Drains Water Heater <br /> SPRINKLER I SUPPRESSION SYSTEM` Sewage Ejector or Sump Pump Other: <br /> Water Suppression System No.of Heads <br /> Chemical Suppression System I No.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 I am authorized by the owner of this property to perform the work for which application is made, <br /> and I comply with the Ste- ontrac aw 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> I lc -5(676a7. 000 <br /> Owner/Authorize. •-1 • ure \/ Date (Revised 10/10/2018) <br /> 1z <br />