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4177- 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 j(E)everetteps@everettwa.gov j www_everetfwa.gov/permits <br /> 31ue or Black ink Only Please,. ;PRO.JECT SITE INFORMATION i . <br /> ROJECT SITE ADDRESS: 373x. ea, 4.5 41/6- PROPERTY TAX#: a99.3?19 /761/ <br /> EGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFCIRMATION <br /> WNER NAME /{'7/ eit..> 'ffi ,/'5ler- TENANT NAME(If Commercial): <br /> WNER MAILING ADDRESS: STREET,3-73.2 axle. .5 6, Q <br /> CnYL�/re !� /STATE / ZIP 9Qp1 <br /> 6/ <br /> WNER PHONE . 5 9 Fel OWNER EMAIL <br /> ONTRACTOR NAME: 8 <br /> ONTRACTOR ADDRESS: STREET <br /> r// jg/5J � 'S� <br /> � � <br /> CITY ®//// &eelk-- STATE //3 09- <br /> ONTRACTOR PHONE: <br /> —ONTRACTORPHONE: 397 //y/y CONTRACTOREMAIL:J. p it.�eG'U4fet.e/ c��'',C <br /> ONTRACTOR LICENSE#(REQUIRED)4 ,L/j/fj LD€9. CITY OF EVERETT BUSINESS LICENSE#(RE(QUIRRED): 94WO <br /> RIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> ONTACT NAME: CONTACT PHONE: ,LL�S3 y7 JL/ <br /> Site Tcah! CONTACT EMAIL: l Wadley/714d x+45; <br /> BUILDING PER IT APPUCATIO;N <br /> xisting Use of Building: keg/Qin-0e a Contract Price of Work:$ �ao� <br /> •oposed Use of Building: Heat Source: lif.Gas ❑Electric ❑Other <br /> .gilding Type: ❑SFR-Detached ' SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> ipe of Project: ❑New ❑Addition ❑Remodel ZIRepair ❑T.I. ❑Sign El Sprinkler ❑Demolition ❑Change of Use <br /> ESCRIPTION OF WORK:* /7 �r�/� /►_ /��/, y <br /> /G�'Pse' �� ,��^ fC 7t.7r / /'mac--� <br /> SSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL,PERMIT APPLICATION PL ,UMB NG PERMIT;APPLICATION <br /> rpe of Project: _New _ Addn _Alteration _Repair Type of Project: _New _Addn _Alteration _Repair <br /> #of #of #of #of <br /> List of Fixtures List of Fixtures List of Fixtures .._. ,.,: . ...List of Fixtures: <br /> fixtures Fixtures Fixtures Fixtures•' • <br /> A/C-Air 1 ari8ting.,Uriifs H atPump'. .`r" "' Toilet Bacrcflovv Pref ef'iterTtrrigide BIdg} <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 1 No.of Heads <br /> 3KNOWLEDGEMENT: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 /> rrent 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 /> rilding Official before being authorized under any circumstance.I am the owner,or 1 am authorized by the owner of this property to perform the work for which application is made <br /> Id I comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> IPERMIT# <br />