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44677- PERMIT APPLICATION <br /> BUILDING / MECHANICAL I 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 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> ,Blare .r slacks Ink Only Please) PROJECT SITE INFORMATION, <br /> PROJECT SITE ADDRESS: •_` e,21 Jt t.eCkjr r `l PROPERTY TAX#: <br /> 'LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> TOWNER NAME: 2 o-ra) jZ TENANT NAME(If Commercial): I <br /> 1 <br /> OWNER MAILING ADDRESS: STREET /��? Z./ Rc X!_ ]�'J 14-L) b 1 <br /> CITY 7 - / t 7t STATE /jog zip ger 3 <br /> 'OWNER PHONE: t7/T7._ 47/— (,S—VL4 ttt OWNER EMAIL: Z L& ) 27 /. &4444 !'GGillr, <br /> jCONTRACTORNAME: I 714-c 4T /<t, �n,J iti,-I (..? id)1&)/4 dn. � -A ) , <br /> II CONTRACTOR ADDRESS:! STREET 4 f S t / ti j�}- flys / j'g_{A Rd <br /> j CrlY ----5"1710‘) L' ® /tJ G STATE a/A ZIP i'Z92.... <br /> CONTRACTOR PHONE: _ p 3 CONTRACTOR EMAIL: S t ( iI AL i -. 4j .8G r't ' <br /> ICONTRACTOR LICENSE#(REQUIRED): 6.6 8 L k) I L.(.X-D%5L CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ,CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: 4{Z5 0Izcs �- �1 <br /> CONTACT EMAIL: l <br /> 1 BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 4,/4 Contract Price of Work:$ _—L J :"' <br /> Proposed Use of Building: ! Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial Dlndustrial <br /> Type of Project: ❑New DAddition DRemodel DRepair ❑T.I. ❑Sign DSprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> �t=- 16 F-Gt4 = -f As3 -r:s e_ r ,, 1Z . <br /> Ittotr <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 /> j Forced Air Systems Unit Heater Bathtub Urinal <br /> p 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 1 SUPPRESSION SYSTEM <br /> IChemical 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 Stat.t,ntrfcto aw 18.27 RCW and 296.200A WAC. <br /> �� / / City of Everett Official Use Only <br /> PERMIT# <br /> , /2//(/ /7 M( 17. .0` 3 . <br /> Ov�lner/Authorize. Agen Signature Date (Revised 9/23/2016) <br />