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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 I(E)everetteps@everettwa.gov I www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 0107 IPMAID AIX- PROPERTY TAX#:01955---M—C69.--6)01-0C' <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: f. 4.1A.A. 44,4_ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET 10101.,�./ V_!O�7 <br /> CITY Ev �/ STATE A ZIP 96" <br /> ��1 <br /> OWNER PHONE: ZoCS�—x'35-491(4'} i OWNER EMAIL: <br /> CONTRACTOR NAME: v USf'aM U G� / <br /> �3..'�j1.Ir. pp <br /> CONTRACTOR ADDRESS: STREET ) LA..) vo 1r4.) 1") F gra (-TS <br /> CITY (10tit)Jt STATE Uj4 ZIP1-2... <br /> CONTRACTOR PHONE: (42s-.....€F)2-`1 p( CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): Ka5`t"DU.I4 4-/0IQ CITY OF EVERETT BUSINESS LICENSE#(REQUIREDI•14,o'La4ae.!a_d J <br /> PRIMARY CONTACT: 0 OWNER ><ONTRACTOR 0 OTHER(Please Specify) -14' L/- . '.4-;"- <br /> CONTACT NAME: �- CONTACT PHONE: _ q,/3 / <br /> � 1( f t4►�f CONTACT EMAIL• _�� Ei-//4-'6,(`J1c,+"�.li 2"l-�Y1G( <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: e,,, Contract Price of Work: $ ,:,--1-`,.--C' <br /> ' <br /> �^..p % <br /> Proposed Use of Building: "1Z.,. Heat Source: , Gas ❑Electric ❑Other <br /> Building Type:e;' SFR-Detached ESFR-Attached 0 Duplex ❑Multi-Family-#of Units: DCommercial 0 Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ,Repair CIT.!. ❑Sign ESprinkler ❑Demolition EChange of Use <br /> DESCRIPTION OF WORK: FiI paw �Dan� ��_, p , -tie$ r app pp�,,�•4v r/q �� <br /> LIPAI a �p tNwN4 I�Z =PGCE DAtt4 ,D K-j&Li ti-,.,�13$ �iutt64."" atto t <br /> fAitASS IATED BUILDING PER T#(if appli able): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New Addn _Alteration?\Repair Type of Project: New _Addn _Alteration }!caepair <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 Z 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 Z, Shower Floor Drain <br /> Gas Fireplace Wood Stove ` Kitchen Sink&Disposal Grease Trap <br /> Gas Range Ducting I Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: I Clothes Washer Medical Gas <br /> i Range Hood _ Water Heater Other: <br /> Exhaust Fan Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER/ SUPPRESSION SYSTEM <br /> Chemical 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•'ial before being authorized under any circumstance.1 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 co • with the State Contra .rs Law 18.27 RCW and 296.200A WAC. <br /> IL 4, <br /> City of Everett Official Use Only <br /> PERMIT# <br /> (-12;-' <br /> • .49Fivirrift Signature •ate (Revised 9/23/2016) <br />