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4577- PERMIT APPLICATIO <br /> BUILDINO I MECHANICAL/ PLUMBING / SIGN-TSPRINKLER/ 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 /> 1 <br /> PROJECT SITE ADDRESS: / 13 'Cis, ) J PROPERTY TAX#: OO Li'3 9 I j''7 4v a 17 0 2.-- <br /> LEGAL <br /> iLEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: 5thkuuIQ Eg(;v e R.— TENANT NAME(If Commercial): AJ1 JE i7( 5- T- L Y <br /> OWNER MAILING ADDRESS: STREET ICI i 3 2.. P 3 o S�- <br /> CITY r ,u e ve STATE Mil ZIP q ¶2-o( <br /> OWNER PHONE: 1-2.5- 2..5-2... 6,3 j "7 TOWNER EMAIL: MO <br /> CONTRACTOR NAME: 6U FJ r <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: IWNER 0 CONTRACTOR 0 OTHER(Please Specify) f <br /> NTACT NAME:,..._ , CONTACT PHONE: SS l S n 4 : \\\ <br /> id iS ''' ;`' ', CONTACT EMAIL: S � { ' <br /> 1 ., ulrA_ <br /> BUILDING PERMIT APPLICATION r9J <br /> Existing Use of Building: ({v i A io, h C.• act Price of Work:$ 1,7G6 c ,WAir: . 31_9_151 <br /> Proposed Use of Building: ,pyi� Heat Source: ❑Gas leiectric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached LDuplex ilMulti-Family-#of Units: °Commercial <br /> Type of Project: ❑New ►'Addition CI Remodel ❑Repair DTI. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK: ADD £eK 1-0 5 v n) D f't.UG Fz- 74-PA-e---77-1 -Al .r-- <br /> o ('<a <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 List of Fixtures #of List of Fixtures List of Fixtures #of List of Fixtures <br /> Fixtures Fixtures Fixtures Fixtures <br /> NC—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 /> 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 I:. ply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> 1 . , \6 U.) U./7 CI 00 CI ( \W <br /> 0 • Aut .rized Agent Signature Date (Revised 5/20/2016) —1 <br />