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12/01/2015 TUE 9:07 FAX 425 379 7045 WA Natural Gas Z001/001 <br /> 4177 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 1 www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> ROJECT SITE ADDRESSn�✓//� PROPERTY TAX#: aJn���� �O�/O3 <br /> ,44 <br /> EGAL for new construction: Short Plat/subdivision Lot No. ((/(attach copy of long legal description) <br /> CONTACT INFORMATION <br /> WNER NAME: D/Va.i j 4,(a�9 TENANT NAME(If Commercial): <br /> WNER MAILING ADDRE&J: STREET /�//�J 5/1 (i pi (cF <br /> CITY fO�) J/C STATE u)/4- ZIP OC/ <br /> WNER PHONE: / 9003-v <br /> -g 6 OWNER EMAIL:d /clghitA `„/S0172/4 6 <br /> ONTRACTOR NAME:A)77Sly)yrArt <br /> 4) aC 4i.„,..‹,' ////L{r Lin <br /> ONTRACTOR ADDRESS: STREET c 9 . ii ,QTS ° 4 <br /> CITY A✓rre STATE A)/'-' ZIP q�J`J <br /> ONTRACTOR PHONE: r.�3 _ j4/'��111 / CONTRACTOR EMAIL: / �J e <br /> / �� ii.4147 ezitCC� S, (7�it1'i'l <br /> ONTRACTOR LICENSE#(REQUIRED): /0 '`! ,6 gj3Lip CITY OF EVERETT BUSINESS LiCENSE#(REQUIRED):Qr// <br /> RIMARY CONTACT: 0 OWNER 173-c;ONTRACTOR 0 OTHER(Please Specify) <br /> ONTACT CONTACT PHONE: �%' �_ V7/(�/t� <br /> cite e/rdh/ CONTACT EMAIL: /(276eJ4 4a /dS ems_ <br /> BUILDING PERMIT APPLICATION ^ ' <br /> xisting Use of Building: -...c/ilk i/ h ..G Contract Price of Work: $ � j` ,(t.) <br /> I V <br /> -oposed Use of Building: ft / rl <br /> p 9 Heat Source: utas ❑Electric ❑Other <br /> Jilding Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> /pe of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Si n ❑Sprinkler ❑Demolition CI Change of Use <br /> ESCRIPTION OF WORK: / <br /> _ <br /> SSOCiATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> rpe of Project: _New _ Addn Ateration Repair Type of Project: _New _Addn _Alteration Repair <br /> #of #of <br /> fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> 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 /> 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 /> Number of Heads <br /> :KNOWLEDGEMENT::/have reviewed this application and confirm the information contained herein is true and correct. Work done pursuant to this permit must comply with <br /> vrent 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 /> rilding Official before being authorized under any circumstance.i am the owner,or lam authorized by the owner of this property to perform the work for which application is made <br /> Id I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> IPERMIT# � �, j <br /> y'r\\51 ` <br />