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4577 PERMIT APPLICATION■ <br /> BUILDINMIECHANICAL/ PLUMBING /SIGRINKLER/ 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.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: /4z7 I & t SI1 PROPERTY TAX#:Zj iSs3D61 6/eD."*•41' <br /> LEGAL for new construction: Short Plat/subdivision frit/fle i.C-2 1 Lot No. Z.-- (attach copy of long legal description) <br /> • CONTACT INFORMATION <br /> OWNER NAME:74 /4r,,i // i 4'i''s /4/77G,S TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: Z. EETT -v )7a/( jrz.a-r/f <br /> &-1--:&iz- _ JJ STATE kri2 ��ZIP / S e-45,-�/ <br /> OWNER PHONE: 1{Z, ' 2J )'41-77?-7 OWNER EMAIL: <br /> tic92/G.1^4 lam' /7l.S�. �'O/s7 <br /> CONTRACTOR NAME: <br /> CONTRACTOR ADDRESS: / AEET /3/jay 71 <br /> (0l • /�/v STATE <br /> w,cY ZIP z3 <br /> CONTRACTOR PHONE: 34,6 - 37- ,e)7 .CONTRACTOR EMAIL: 7775 4/' /, # Eitolutf445 , <br /> CONTRACTOR LICENSE#(REQUIRED): 147,/lC`f qho,‹ CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ,, '-�f CONTACT PHONE: t(2_,5"-- 7,5,57,5,5� - 0934" <br /> 't <br /> 74 /aael �' CONTACT EMAIL: &p -, i - 0 ,i7. e-t9/27 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: F.i> Heat Source: Faas DElectric ['Other <br /> Building Type: ZPFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial CI Industrial <br /> Type of Project: 't, ew DAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition OChange of Use <br /> DESCRIPTION • WORK: <br /> j.c._ . h .-Ti---/7-7- ,./, /ems v <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: XNew Addn Alteration _Repair Type of Project: 1 dew Addn Alteration Repair <br /> #of �" — — <br /> Fixtures List of Fixtures #°f List of Fixtures #of List of Fixtures #of <br /> Fixtures Fixtures Fixtures List of Fixtures <br /> NC-Air Handling Units Heat Pump 3 Toilet Backflow Preventer(Inside Bldg) <br /> / Forced Air Systems Unit Heater / Bathtub <br /> Urinal <br /> S Gas Piping Boiler 5- 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 // Roof Drains <br /> / Clothes Dryer Hookups Other: / Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> 5 Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER t SUPPRESSION SYSTEM <br /> 'Chemical or Water I INo.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 fro 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 applica' e, <br /> and I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only Z <br /> Z/,)-.- I PERMIT t V 0241 <br /> 7 : <br /> Owner/Authorized Agent Signature ~ <br /> Date (Revised 9/23/2016) <br />