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4t-77 PERMIT APPLICATIO <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 I FAX 425-257-8857 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: . PROPERTY TAX#: <br /> I `1(11L ,-"'"� <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION / <br /> OWNER NAME: �/'ie�rrl�,� c.\\ vr�w�c i �'l TENANT NAME (If Commercial):Q/'Gv4_ 7i'I�cf t! 7:7.4 25$ <br /> OWNER MAILING ADDRESS: STREET /lac 7-331-46)I i <br /> CITY !N"l yl"l�l ir, h 'b STATE . -� ZIP ��0�'���I <br /> OWNER PHONE: OWNER EMAIL: <br /> CONTRACTOR NAME wcJI(-C 16.1/ ),fryj <br /> CONTRACTOR ADDRESS: STREET / 77;2 <br /> CITv �//(aSTATE W/`I ZIP -_ <br /> CONTRACTOR PHONE: ; 79-1 g-6)I CONTRACTOR EMAIL: O <br /> ��' C�C� n W rer ,:c.nm <br /> CONTRACTOR LICENSE#(REQUIRED): tVIPLI C��n 3C� CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): >' '(`� <br /> PRIMARY CONTACT: 0 OWNER aCONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4K-) `661)2( <br /> CONTACT EMAIL: i` Kcc,CD IA0{ �t Cow, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ [./ O, � <br /> Proposed Use of Building: Heat Source: DGas ❑Electric ❑Other <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 0 Industrial <br /> Type of Project: ❑New ❑Addition DRemodel ❑Repair ❑T.I. ❑Sign DSprinkler ❑Demolition CiChange of Use <br /> DESCRIPTION OF WORK: • <br /> ,� /� �� <br /> `V V/A[01 fAr &w b <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 ?C ,41teration _Repair <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC—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 I Water Heater Other: <br /> Exhaust Fan i 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 the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> PERMIT# <br /> L07/(6 <br /> Owner/Authorized Agent Signature Date (Revised 10/12/2015 <br />