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44.77PERMIT APPLICATION' <br /> BUILDIN( __/IECHANICAL / PLUMBING /SIGN-- RINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: / y., 3 ( Cn 51-PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: JL/ 5+ )4 Le-A -t �t=L Lu 1.✓ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET SG(✓ti(_ <br /> CITY STATE ZIP <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME: �}t2-,00 a S LS: CI e:-yhat4C4i-evj 'TA/ C <br /> L. <br /> CONTRACTOR ADDRESS: STREET LH 5 f N K:67.6 E7' G, 3 3 <br /> IM g,k 12-e- CITY STATE W)4- ZIP �I' <br /> CONTRACTOR PHONE: t/)fit' s Egg CONTRACTOR EMAIL: 01--01?Ca; 5rt© Cp L'✓„ e;m, (�V <br /> CONTRACTOR LICENSE#(REQUIRED): fi ZAD C jC9 r N CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: 0 OWNER EAONTRACTOR ❑ OTHER(Please Specify) <br /> CONTACT NAME: ( 1`��+ C �"�/<<t'i S 7 CONTACT PHONE: 6_ y-- 1 <br /> 6; /rt- (--"C-At (t o L y^, � fs CONTACT EMAIL: 5ct o-i� <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas 0 Electric DOther <br /> Building Type: **FR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: ,n, _ <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 I comply with t e State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT#ok,„,gr • (c, <br /> L ?/Aut Pzed Agent Signature Date (Revised 10/12/2015) 0 <br />