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44-77- PERMIT APPLICATIO" <br /> BUILDIN( MECHANICAL / PLUMBING / SIGN PRINKLER/ 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: IG :a 4 l . �1 V PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 1SI-.L f�JZ.,I� L-1,1,• �t TENANT NAME(If Commercial):` ,,C111e.,li rt' . (,;(v y/� <br /> OWNER MAILING ADDRESS: STREET 1( ^:)-�'' ) I{��!�l '/"V.,, Y2, Vi �/ ' <br /> CITY J��K-�i4. STATE V..ja-- ZIP +�'2_04 <br /> OWNER PHONE: 7� -`71I 3' :_--1--14.-)1+4;3 OWNER EMAIL: <br /> a %i'1 i�f•P�f,± ` fki) l_tiY"14 _t_,•l,(.�t►t1Y1 <br /> CONTRACTOR NAME; (yam � I � , <br /> 1 'J <br /> CONTRACTOR ADDRESS: STREET f� E�4`� ( <br /> CITY M f k t U STATE KV ZIP (1329-c-) <br /> CONTRACTOR PHONE: 2( 1/'\�C ~(�j��, CONTRACTOR EMAIL: L i r' t,�i `'/ �()Yl �k.+1 v (i_cyn <br /> d <br /> CONTRACTOR LICENSE#(REQUIRED): e —II"�C-�n/` (,�, ,4 CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): t) . k „1\it% <br /> PRIMARY CONTACT: 0 OWNER 7 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: /,0 -IV.S� .i LDof l <br /> 14V UL 1/L&UL-i 1 CONTACT EMAIL: I1'4k Lt N�f11 h10�rJ tr 5. ( c' — <br /> BUILDING PERMIT APPLICATION <br /> J <br /> Existing Use of Building: f J 1 IAZIjc /+f1-f_C4 1,:i,,,I�l Contract Price of Work: $ k10010 <br /> 1/4 <br /> Proposed Use of Building: Heat Source: IgGas DElectric ❑Other_ __ <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex DMulti-Family-#of Units: _ Commercial El Industrial <br /> Type of Project: ❑New DAddition DRemodel %Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ( k <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 #°f List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> I 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 /> - <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/comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> 7 I City of Everett Official Use Only <br /> d 11, <br /> PERMIT# 1 _ <br /> k'l/ <br /> Owne1/hor ed Agent Signature Date (Revised 9/23/2016) <br />