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44-77 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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only <br /> Please)� PROJECT SITE INFORMATION ,y�� z, �> <br /> PROJECT SITE ADDRESS: I``J(0 �c"eU I 6/ PROPERTY TAX#: G(�(J ✓ 'O7( .70D <br /> LEGAL for new construction: Short Plat/subdivision .tLot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: c 0\1)(\ COU TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET-79 co ,•vej` 6tOZc <br /> / (`CCITY j ( 7 " STATE c _ ZIP <br /> 4 7 <br /> OWNER PHONE: '�rz__„��""�� & 7 OWNER EMAIL: Ce -e-,t (.1p <br /> / F� - <br /> CONTRACTOR NAME: •���� (')v,(1.--,c' ��t/)� � ''a �JJ <br /> CONTRACTOR ADDRESS: STREET <br /> 1 <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): N� <br /> 1)--17-1L-Th <br /> PRIMARY CONTACT: 1=1 OWNER 0 CONTRACTOR 0 OTHER(Please Specify) " <br /> CONTACT NAME: CONTACT PHONE: <br /> N.) 0 cCONTACT EMAIL: /--- <br /> ---------- ----` <br /> BUILDING PERMIT APPLICATION 11 <br /> Existing Use of Building: Contract Price of Wor $ �1"Ud C'� <br /> Proposed Use of Building: DAA P V, Heat Source: , Gas VElectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: 681 ❑Industrial <br /> Type of Project: aNew ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: rd <br /> * v <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 List of Fixtures #of List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C–Air Handling Units / Heat Pump / Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> / Gas Piping Boiler j Lavatory(Wash Basin) Drinking Fountain <br /> ( Water Heater Refrigeration / Shower Floor Drain <br /> / Gas Fireplace Wood Stove / Kitchen Sink&Disposal Grease Trap <br /> j Gas Range Ducting je 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 /> Chemical or Water 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 State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> J ✓t -G ? (/� -�� PEJT#� � r c <br /> Owner/Authorized Agent Signature Date (Revised 9/23/2016) -'14-Th <br />