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44-17 PERMIT APPLICATION <br /> BUILDING ECHANICAL / 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 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: �- PROPERTY TAX#: <br /> ;goo <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: ,S t- L�,—� L,�y.-,l TENANT NAME(If Commercial): Fe4,-- I tcf•2 C owl /Li <br /> OWNER MAILING ADDRESS: STREET moo Ltt <br /> cm( (—l/t—a--1✓,1 STATE A ZIP el ij L 3 <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: I <br /> CONTRACTOR ADDRESS: STREET FO (2› ,1C QCiL—(- <br /> CITY f• -`G STATE W A- ZIP '1 li 01-6 <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> e 51)2 <br /> CONTRACTOR LICENSE#(REQUIRED): /t , : , k ce,c, t CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER CtONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 2_04, `, s-- r v C <br /> l�v�i D J�S CONTACT EMAIL: ,J(,.z (bc! /( ..C <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ 2_ C5 — <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel El Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1,A4A--e4-( I NL go -NA,A, <br /> HO)srwh`f segiNfr-L.&-71- 5 <br /> E C1/4c- fLoEs . Vc`ii,7141.-c7 If /2,! <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 /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.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 1 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (lit-3 iL 1 .1I( - DOS <br /> Own TAI o zed A ent Si nature Date� (Revised <br /> 9 9 10/12/2015) <br />