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41.77. PERMIT APPLICATION <br /> BUILDINOMECHANICAL/ PLUMBING/SIGN / RINKLER/ 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 /> PROJECT SITE'INFORMATION <br /> PROJECT SITE ARESS: i PROPERTY TAX#: <br /> 7' 74 uergr�eey, w4ty Juefr'! <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION; . <br /> OWNER NAME: TENANT NAME(If Commercial): Wei 4 114- tAit-' c Iteo's" <br /> OWNER MAILING ADDRESS: STREET I <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: gq la. n e e Pd ,`-'.% 4- CO P Ki 4 it e4 .117 <br /> CONTRACTOR ADDRESS: STREET P 0 &a m )9s-s— ` e /� <br /> CITY 1(.&/)/s V 1 I L e STATE Id ZIP 9 8.2 76 <br /> CONTRACTOR PHONE: (4/2 0S 6 8' 012 e/ CONTRACTOR EMAIL: u a giv J^A.ba 1 sS-ervs e of rdtr, <br /> CONTRACTOR LICENSE#(REQUIRED): e4LA 10 PC /Ivl 1 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED):( S O 40 41 <br /> PRIMARY CONTACT: 0 OWNER RI CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: ...-ci. e5 )614 SOvl <br /> CONTACT PHONE: ( �/2 --15-6 p i 2 e f <br /> vvi <br /> CONTACT EMAIL: 4 1„./es e9 j, l e et et ice,ted-Sei'v.ze e 7 I C <br /> BUILDINGPERMIT APPLICATION <br /> Existing Use of Building: LI e t J q (-v 'AI 4 r.a j,. et 4.1,4" Contract Price of Work:$ /21 -5-42— <br /> Proposed Use of Building: Heat Source: ❑Gas Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ODuplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair lr.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> c H,, X7U <br /> DESCRIPTION OF WORK: (a C i�d -4 P, <br /> e v►10 e c 7C,`s •',�q '�. S.f o,� lI ea 4 � f� �e� °C <br /> h e a.9 i t( S.0 E R a el/o A -r„m e J.:i e c) cc/ Jq t e en ret 7-. P-1'14 (roll a-3.-1i'z-r...r <br /> tel)4f ITipit ,S,vvi <br /> ble'e p-e4e 4J K4- 0d vx .c vt d ppr�4 <br /> ASSOCIATED BUILD <br /> MECHANICAL PERMIT APPLICATION , PLUMBING peRmirr 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/;:SUPPRESSION SYSTEM : . <br /> Number 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.lam the owner,or lam 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 /> ,I, �� zd s4 , Aa 1&Pl—Oifg <br /> Owner/Ar rized Agent Signature Date (Revised 10/12/2015) <br /> BIZ <br />