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411, <br /> PERMIT APPLICATION. <br /> + BUILDING / MECHANICAL I PLUMBING /SIGN / SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (04ETHP)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 77 <br /> PROJECT SITE ADDRESS: 1)-I 3 8'17 51 PROPERTY TAX#: GU'7�/9' /�(-1 co/yCu <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> I CONTACT INFORMATION <br /> OWNER NAME: GLIc1C1 lr ri C KS( if/ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 7 2/ 3 8 t Sr <br /> CITY (j(i-CfT STATE (C/l 0t '-"P gem 7V/y <br /> / <br /> OWNER PHONE: C((� �FD �7e�/ `� OWNER EMAIL: (I+A g-IC.uS(./JFv}'/v'if") . - '& <br /> CONTRACTOR NAME: Hurls 11�S (2 17 1rr/c ti /i Q C <br /> CONTRACTOR ADDRESS: STREET PO 6 f1 Q1 /� <br /> CITY S 'G'lr('�i`5 4 STATE Cc)aI ZIP NJC`�(�/ <br /> CONTRACTOR PHONE: .560 " 7 _. l U 0 3 CONTRACTOR EMAIL:• /F� <br /> CONTRACTOR LICENSE#(REQUIRED): KCtrli I'C(,gZ 1 f C CITY OF EVERETT BUSINESS LICENSE#(REQUIREb). (4t,i J <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR i&OTHER(Please Specify) Dl5/ytter <br /> CONTACT NAME: CONTACT PHONE: L()I 7qd- - C`, . i,- <br /> 61- (. b( 1-61c- CONTACT EMAIL: (,t)C(f, 4.6147 k2 L f ed0/"! <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ <br /> Proposed Use of Building: Heat Source: ❑Gas (Electric ❑Other <br /> Building Type: ❑SFR-Detached ! SFR-Attached ❑Duplex 0Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ISIiAddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> ;51—CAz� s4r Ci' 'c�� i, i <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 /> I A/C—Air Handling Units i Heat Pump '�, Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater 1 Bathtub Urinal <br /> Gas Piping Boiler 3 Lavatory(Wash Basin) Drinking Fountain <br /> 1 Water Heater J Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove t Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> 1 Clothes Dryer Hookups Other: 1 Clothes Washer Medical Gas <br /> i Range Hood I Water Heater Other: <br /> '3 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 RC W a d 296,200A WAC. <br /> .------`/` � City of Everett Official Use Only <br /> ry>,-; PERMITS <br /> / , ..........---1, 5--. /e :.) : S0 9 --(0 0 5 _, <br /> (Ownd/Authorize A e gnature ate (Revised 9/23/2016) <br /> 6 <br />