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41) <br /> PERMIT APPLICATION <br /> PP <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> • <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) �7. PROJECT SITE INFORMATION/ , <br /> PROJECT SITE ADDRESS: 32/� t,-,VZ% ,4 4 Ef/.e„" K/(,,, ,�PROPERTY TAX#: 0,0439®? 96 2 f/Oo <br /> LEGAL for new construction: Short Plat/subdivision Lot No2T-7 (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 32/7 40442/ II G TENANT NAME(If Commercial): <br /> OWNER L MAILING ADDRESS: STREET/�f?C s&i,2 7i 7 1, , <br /> 4.'7 V` lr crry 49- �f/"f4VI I/r STATEI(JC ZIP %1-7.9 t1 <br /> OWNER PHONE: C/ 77 — 73` 1371 OWNER EMAIL: <br /> CONTRACTOR NAME: elre(415r-0(11 <br /> CONTRACTOR ADDRESS: 1 V3 G ' \ A V-e IA <br /> rr. c ev‘S V l\l'( ciTtiJ 4` a Ct g x..1 % STATE ZIP <br /> CONTRACTOR PHONE: 425-22.G--2--gS'Cb CONTRACTOR EMAIL: KeU"'n Coc4G,,22.- ycoNoo 0 <br /> CONTRACTOR LICENSE#(REQUI ): , et OF EVERETT BUSINESS LICENSE#(REQUI D)Co� <br /> PRIMARY CONTACT: ❑OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: '/Zy-_/ �3/ — y? ,ly , <br /> S�a� iJJ, /V Ae� .�( CONTACT EMAIL: /,P:'h b A(4)S�� /c>'Y�'// o„ll---- <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 6efp/ /.0/ Contract Price of Work:$ S(27 01.70 • ,..---- <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric El Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ®Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair CT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ,p�M�� <br /> Cr% ► ccL t} ecS cscr 'G Q _2 17.A-e N® l.> c2t-c r <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 /> 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 I 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 horized 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 Stat tractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PE IT# <br /> .�-27-7�1�' k iOs —022/ <br /> ri Agent Signature Date (Revised 9/23/2016) <br /> YZ <br />