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44-17- PERMIT APPLICAT• <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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: it)G// E VF/t'#teeN G✓ / PROPERTY TAX#: Zt O421'OO L 03/00 <br /> LEGAL for new construction: Short Plat/subdivision Lot No. )e (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f p. k IV f/ley a /,4./ f,ri 1Q AgENANT NAME (If Commercial): Az e/N //a of/j 9. <br /> OWNER MAILING ADDRESS: STREET 4.g . fi'A' 7 83 0 <br /> CITY o-L-- 7r STATE 1,4„.-If ZIP yefZ/3 <br /> OWNER PHONE: OWNER EMAIL: ..-- <br /> CONTRACTOR NAME: Cj ofPPA/c 9 C C di'.J' 72 L G p/ON /A.0• <br /> CONTRACTOR ADDRESS: STREET 8 /0,s 9/1011`494✓/j4f d <br /> CITY STATE % ZIP 99 t 03 <br /> CONTRACTOR PHONE: ( 9e-25') ?S S-Y0 0 CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): Q 1 / /VCZ /O fie..?ie..? CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: ❑ OWNER ❑ CONTRACTOR ,[TOTHER (Please Specify) A/Lc if/T lG/ <br /> CONTACT NAME: 2, f 2 /}/LG/1/?27 � CONTACT PHONE: /Le St - (¢zr) 2,5- - 2/•C-3 <br /> CONTACT EMAIL: rvtt' e 2 /2 a . <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 'I., v P 4' t 6W f///I' Contract Price of Work: $ 9 2 5 o l-v <br /> Proposed Use of Building: A AC i¢c.‘,/LJYW// Heat Source: Xas ❑Electric DOther <br /> Building Type: ❑SFR-Detached EISFR-Attached ❑Duplex ❑Multi-Family-#of Units: ,Commercial CI Industrial <br /> Type of Project: El New °ddition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition CI Change of Use <br /> DESCRIPTION OF WORK: 5� b 1..7 .C�,F ,off f/ c.AL <br /> y /i-j 2, ¢/ S' J F• J cf t C cr /1- /7 to", T/Wcr <br /> J o t, t, J'/rl er e p Ear/ fi r..vl/ <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 #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of Fixtures Fixtures List of 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 /> Chemical or Water 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 /> i 1 <br /> a—x-. //• 2/• /7 1.-1 ct-t <br /> Owner/Authorized Agent Si nature Date (Revised 9/23/2016) <br />