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4.77PERMIT APPLICATIO I <br /> BUILDIIIECHANICAL I PLUMBING I SIGN -I'iINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVIC b <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.govlpermits <br /> j <br /> PROJECT SITE INFORMATION. . .. . . . <br /> PROJECT QRESSScipgq �t,yt�i'ee� 9PROPERTY TAX#: <br /> fAAva-M-lia A-LEGAL for new construction: Short Plat/subdivision `,� Lot No. (attach copy of long legal description) <br /> „: CONTACT INFORMATION. <br /> OWNER NAME: 5r2,4 -- F.\1Ct -- _ TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET `Cbg 0. to..�/�„e. tJj `J Ifa <br /> CITY it/VOA C STATE L.1.k ZIP C 0I <br /> OWNER PHONE: 46—4'1314 3 0 3`i-µ OWNER EMAIL: i'C p{'-"(�1(`eA y\1 et O `( I'1')e,t I. 03 re% <br /> CONTRACTOR NAME: 4 W1ve 1 <br /> CONTRACTOR ADDRESS: STREET <br /> CITY STATE ZIP <br /> CONTRACTOR PHONE: CONTRACTOR EMAIL: <br /> CONTRACTOR LICENSE#(REQUIRED): CITY OF EVERETT BUSINESS LICENSE#(REQUIRED): <br /> PRIMARY CONTACT: %OWNER 0 CONTRACTOR 0 OTHER(Please Specify) <br /> CONTACT NAME: CONTACT PHONE: <br /> CONTACT EMAIL: <br /> :; BUILDING PERINIT APPLICATION !. . . '.: .:::! i!::1';:,.::;.,-;,-i. ..,:::,.,7,!:...':!!!:' ... <br /> Existing Use of Building: Contract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric DOther <br /> Building Type: OSFR-Detached DSFR-Attached °Duplex ❑Multi-Family-#of Units: °Commercial ❑Industrial <br /> Type of Project: New °Addition °Remodel °Repair. DT.I. @Sign ©Sprinkler El Demolition DChange of Use �, <br /> DESCRIPTION�'OF WORK: /taw Co�t5 •� _ 042. 17e71_ c4jce*(tQtlT Sr 2L4 <br /> .x,30 t <br /> (/ <br /> ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION::. . . .. : : PLUMBING PERMIT APPLICATION. • <br /> Type of Project: VNew_ Addn _Alteration Repair Type of Project: , New _Addn _Alteration __Repair <br /> #of List of Fixtures #,of List of Fixtures #of List of Fixtures #°f List of Fixtures <br /> Fixtures . Fixtures Fixtures 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 '" I 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 1 Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups • Other: Clothes Washer Medical Gas <br /> Range Hood - Water Heater Other: <br /> ( Exhaust Fan i Sink(Service/Bar/Mop/etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number 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!comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> � • / J L PERMI,�,#1 0 5._62 <br /> • . ,. _ .rized Agent Signa-ur= Date (Revised 10/12/2015) 6 ., / <br /> I/lU <br />