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46-77- PERMIT APPLICATION <br /> BUILDING / MECHANICAL/ PLUMBING /SIGN / SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (F)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov I www.everettwa.govlpermits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 58 o Ak.4 PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> k <br /> CONTACT INFORMATION <br /> OWNER NAME: ( , f GC TENANT NAME(If Commercial); <br /> OWNER MAILING ADDRESS: STREET ig y A <br /> CITY( "G.3 *^C t�C! :. STATE wfi— ZIP 9 z.a 5 <br /> OWNER PHONE2.5 7LQO `150 5 OWNER EMAIL: <br /> CONTRACTOR NAME: ,001 li14 ()C.--- <br /> CONTRACTOR ADDRESS: STREET `6'/ -"�`Yipcid J..Xu.( /a te <br /> ci, ezA e'tJ STATE WA ZIP 7? 0 1 <br /> CONTRACTOR PHONE: p„.59 OS CONTRACTOR EMAIL: cletjaie, i'C:I'a4r1 tvieai 6 Jc.,0yyi <br /> CONTRACTOR LICENSE#(REQUIRED):C.MVitet.YY1,V\ ,`-Ila r CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): IFCCIq <br /> PRIMARY CONTACT: 0 OWNER 0 CONTRACTOR 0 OTHER(Please Specify)_ <br /> CONTACT NAME: CONTACT PHONE: `.. 59 t_ <br /> `�� J CONTACT EMAIL: de..�b►r� Ecmhea*fij •?C.M <br /> I <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: Contract Price of Work:$ 52. -co <br /> Proposed Use of Building: Heat Source: DGas electric ❑Other <br /> Building Type: SFR-Detached ❑SFR-Attached ODuplex DMulti-Family-#of Units: ❑Commerclal ❑Industrial <br /> Type of Project: ONew ❑Addition ❑Remodel ❑Repair ❑T.I. OSign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: <br /> 1 vis A 1 c c� e.ss heo.+?"VK,° <br /> ASSOCIATED BUILDING PERMIT#(if appijcable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: New Addn _Alteration _Repair Type of Project: New Addn Alteration —Repair r <br /> Fixtures List of Fixtures Fixtures List of Fixtures #of List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures <br /> NC–Air Handling Units J 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 1 SUPPRESSION SYSTEM <br /> Chemical or Water J 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 171051 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 em authorized by the owner of this property to perform the work for which application is made, <br /> and 1 comply with the State Contractors Law 16.27 RCW and 296 200A WAC. <br /> City of Everett Official Use Only <br /> r: PERMIT#\ t .. I ` <br /> `Owns /Authorized n ignature Date` (Revised 9/23/2018) <br />