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40 PERMIT APPLICATION• <br /> '1,—:i <br /> BUILDING/MECHANICAL/ PLUMBING /SIGN I 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: 22 '1 441 4725•) /41/,.-..4I/0a- ti✓I 24 OPERTY TAX#:639 t 1 , 1� -) <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME,.¢_, , JY OA" TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 12771 Hari/. ..„-• A I/S _CITY C.VJr-c/y44 STATEW� �/0f41 ZIP U¢ t) <br /> L OWNER PHONE: �2`7✓ / �i7 _7- %y OWNER EMAIL:j fr P2 Q "&'"awtai 4c w c, t <br /> CONTRACTOR NAME: CX dLs" <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUI D): j <br /> PRIMARY CONTACT: IV OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME✓►e_5 5J 4 gj, CONTACT PHONE:-12rJ`- J i� gzi <br /> �JJ CONTACT EMAIL:1„L,5 -,514c1.,,,.,i"/� C=1)4/et/4 <br /> / / BUILDING PERMIT APPLICATI <br /> Existing Use of Building:s /.t Path,I INi a�"� le-S_ Contract Price o o. 15700C) <br /> Proposed Use of Building:si✓✓ t rprn,'�/�'Y,lrmw� �LSo Heat Source: as L'3'Electric er <br /> BuildingType: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family of Units: Commercial ❑Industrial <br /> YP <br /> Type of Project: ❑New ❑Addition eRemodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> di DESCRIPTION OF WORK: ,s46 -J,)> Let/ild, h uv G v 1" or) �,,'Y /� 1- pc�rd- 044,0( <br /> t�-WW avM/ ,t':c. ,r p6Y�,, >/e. Ford-, 15 50.1r s fl`i j , ,401. 0-F6c�.,Zt,a•9� k s k 8..., <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 _Alterati• _Repair <br /> #of List of Fixtures #of Li• of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> A/C—Air Handling Units eat Pump Toilet Backflow Preventer(Inside Bldg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Piping Boiler Lavatory(Wash Basi Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace Wood Stove Kitchen Sin •isposal Grease Trap <br /> Gas Range Ducting Dishwas.-r Roof Drains <br /> Clothes Dryer 'ookups Other: Clot Washer Medical Gas <br /> Range Ho•. : er Heater Other: <br /> Exhau an ink(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 u der 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 ith the State Contracto 18.27 R W and 296.200A WAC. <br /> City of Everetttt Officialr� Use Only <br /> nll y� <br /> /4:2-,-(//1(?5- PE=T# `RClJM CJ S <br /> O J.n /Authorized�Aggent Siggnnaa re Da (Revise+ •/23/2016) <br /> V ed <br />