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44-77- • PERMIT APPLICATION. <br /> BUILDING / MECHANICAL/ PLUMBING / SIGN / SPRINKLER / 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 /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 324 I 1 WAVE -Da PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision__ Lot No. (attach copy of long legal description) <br /> i� CONTACT INFORMATION <br /> OWNER NAME: P r-i1 AO301-16 MA(LT t,1 TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 3LI11 I✓JAVE 72, <br /> CITY .A/E(2,-e.--n- STATE IAA ZIP 987_0(o <br /> OWNER PHONE: 1.125 2%2 3210B OWNER EMAIL: <br /> CONTRACTOR NAME, HEARTH S\DC- Arlt HOME <br /> CONTRACTOR ADDRESS: STREET )-4820t �1 1 116TH ST SUJ (� rJ I_ <br /> ([7 <br /> CITY 1--`1 A N W Uc1D S PATE W A ZIP 9 eo J <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): i CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 4019 <br /> PRIMARY CONTACT: 0 OWNER i CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: GeIDERGy CONTACT PHONE: Lr7_' 7-1 1 (6.13 <br /> 1 CONTACT EMAIL: Ae.-fHS\Qcims9\AOMt@ \IAfloo t(-o,N1 <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work: $ a 200•`v <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: DSFR-Detached DSFR-Attached ❑Duplex ❑Multi-Family-#of Units: DCommercial ❑Industrial <br /> Type of Project: ONew DAddition DRemodel DRepair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition DChange of Use <br /> DESCRIPTION OF WORK: Gks PL L)mi-6I rfb- fa,idt, E) is firo, L;,1E- IK--r° f pi2£PLE 1k( 1- ? ®.r51pi. <br /> 1)&0— rum g6'2- 2E-0.4) aft_ T l a,,Eel-Arr,6- V6-41- ;4 S <br /> MA- <br /> AS 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 I #of <br /> List of Fixtures #of List of Fixtures #of List of Fixtures 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 /> 7_ Gas Piping Boiler Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> 1 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 /> 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 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 /> r(\n—C)g• '.-- OLC IR' 1 <br /> -7//3//i 7 <br /> Owner/Authorized Agent Signature t' Date (Revised 9/23/2016) <br />