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•41E-17 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 Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: i J/ G j4/ ir--61110 PROPERTY TAX#:C0.71�d ���1►y'r <br /> LEGAL for new construction: Short Plat/subdivision - (attach copy of long legal description) '"` <br /> / I <br /> CONTACT INFORMATION <br /> OWNER NAME: /v_ G�zQ,(,) TENANT NAME(If Commercial): ^('' <br /> OWNER MAILING ADDRESS: STREET '3 '1/77/JP A L \, \ <br /> CITY �'_ J�_ !JC!/1�I7 STATE(4 l Q ZIP <br /> OWNER PHONE: , r ' I"(��- OWNER EMAIL: V`I <br /> (..9°C1 ) <br /> CONTRACTOR NAME: C—Z.34. 16-1 1Q/U <br /> CONTRACTOR ADDRESS: STREET A ....., v.E <br /> CITY STATE ZIP ♦ <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: I • 1 <br /> :�%/CONTRACTOR LICENSE#(REQUIRED) G'C.AQ 2R �12—. CITY OF EVERETT BUSINESS LICENSE#(REOUIRED): ®lA P Q <br /> 7 <br /> PRIMARY CONTACT: ❑OWNER El CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT//NAA�M��E: l / (l/� CONTACT PHONE:4z c —1 Z7A'' <br /> 2---bP V'l d t C/1�--t '-I CONTACT EMAIL: .7„,A, IjL ,i6xja /`"v 4 ,cett <br /> BUILDING PERMIT APPLICATION 7 l <br /> Existing Use of Building: Contract Price of Work: , <br /> Proposed Use of Bui ing: Heat Source: DGas Electric Other <br /> Building Type: e...S/FR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Lz7 Type of Project: New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign OSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> --lCiA i r > C <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 Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> I, _Gas Fireplace Wood Stove [ .Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting _Dishwasher Roof Drains <br /> ,i Clothes Dryer Hookups Other: ( Clothes Washer Medical Gas <br /> ( Range Hood ,.---(_-- r ea 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 /> C----. 4/4-.4a1 /7 70/7 1103-.0/1 <br /> Own thorized gent Signature Date (Revised 9/23/2016) <br /> id <br />