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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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I L 2S CAI2At/vo Ail J174--ClL I PROPERTY TAX#: xi 036,ZZ 300 3c <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: j I L.L_ (_'{SIrtf) TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 1 ( 2- Gj &I►2-AT 7 A-1J(i <br /> CITY STATE v"A-. ZIP 98 2_c ' <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: --r.is , IJ <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑CONTRACTOR ;.OTHER(Please Specify) i ' tG.-/,/ii150_ <br /> CONTACT NAME: CONTACT PHONE: -226,0 6,29 d Sc' <br /> l 'lam%-A1 ) r2 O {2N Y CONTACT EMAIL: f\-2. Ckva02 a wood 60(2^...y 160 fry! <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: f/2 Contract Price of Work:$ 40/ O SJou <br /> Proposed Use of Building: C-7 -.12_— Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New 'Addition 6Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> —PO a--4VA2 Aro v►--r10 I/J a P - t2- <br /> ►z�/Na./"`rZ.o►.) p A�r of d Li"(via Pn--� .0.0Lam- r t- <br /> - 4c—e ALT -1z t'r pork, t-F- ,�.I C1 Z-( <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New X Addn Alteration Repair Type of Project: New K Addn y 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 l Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler ',f,,' Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration I 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 /> 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 /> PERMIT# <br /> One Authorize gent Signature <br /> Date ! <br /> (Revised 9/23/2016) _ <br />