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4:77- 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 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: 7/Z.% � , ' PROPERTY TAX#: , /-e4r 1J;:</..Y.a ''`f <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: TENANT NAME(If Commercial): aixne4O0 sr3.;/,I <br /> OWNER MAILING ADDRESS: STREET J,2o:3 /NiD&JST2V mss'?, :s'E ) /� Qcfynn <br /> CITY Gy,�/�E'77 STATE /(41�`/ ZIP 3 <br /> OWNER PHONE: 4-41S-- 5 Fig " OWNER EMAIL: /053e.'/ Q,e��GO,zcc-.C',S-4jrtt,6.9,t1 <br /> CONTRACTOR NAME ; . i`/-t a fr 5 <br /> CONTRACTOR ADDRESS: STREET MX., S"P"' E <br /> CITY /71L,7/yJ STATE Gr%r! ZIP 7,47/ <br /> J47/ <br /> CONTRACTOR PHONE: d5.3—,..24g_ i?'? CONTRACTOR EMAIL: JC/ $"/17iiiOj/{t Art ire,w/i''1 <br /> CONTRACTOR LICENSE#(REQUIRED): j/t)i r/1 f3/S`:.)T CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): 3C-77- <br /> PRIMARY <br /> S77- <br /> PRIMARY CONTACT: 0 OWNER CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: - EFF is', it F( CONTACT PHONE: O aW—.2G=fi7 <br /> CONTACT EMAIL: :•/`14A,fit,679zt/fh it;re <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: /l)/)/U"t'/`/fL(UiZ/eti/j Contract Price of Work: $ 3(> <br /> Proposed Use of Building: ivh4rauFacrea WA- Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached 0 Duplex ❑Multi-Family-#of Units: ❑Commercial ❑Industrial <br /> Type of Project: ❑New ❑Addition ❑Remodel ❑Repair ❑T.l. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: 1./30/•e}"7ilEEk/511V67 6P,21vi/I CL 'c T <br /> Re[� ►n3L i hE NSI sit/iv/tui, t ,V7 t te11W/ZS <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'eater) 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 Official before being authorized under any circumstance.lam the owner,or l 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 nd 296.200A WAC. <br /> City of Everett Official Use Only <br /> /! PERMIT# <br /> I>Lt , C4 it! <br /> Owner/Authorized-Agent Signatur �' Date (Revised 9/23/2016) <br />