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477- PERMIT APPLICATION <br /> BUILDING /MECHANICAL/ PLUMBING /SIGN /SPRINKLER I DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 1 FAX 425-257-8857 1(E)everetteps@everettwa.gov 1 www.everettwa.gov/permits <br /> (Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS:yvy5/-.S_ eeeyett fm// PROPERTY TAX#: <br /> LEGAL for new construction: Short Plat/subdivision Lot No. (attach copy of long legal description) <br /> CONTACT INFORMATION <br /> OWNER NAME: jAtsrey- TENANT NAME(If Commercial): <br /> OWNER MAILING ADDRESS: STREET '/ f 6, ‘a{ieett Ally/ <br /> CITY A`GeLi1 _ STATE �� ZIP !44, <br /> /i <br /> OWNER PHONE: ff OWNER EMAIL: v <br /> CONTRACTOR NAME: A.//td Aie.e.. 4 Seadlg/fy <br /> CONTRACTOR ADDRESS: STREET lair eevr2 Aor: Iv <br /> CITY jeGAi STATE/X/7P. ZIP .+ O•.32- <br /> CONTRACTOR PHONE: /24:-. ty5-, ,; e, - . TOR EMAIL:,-Ay —,4//,vs,-- s ,do <br /> CONTRACTOR LICENSE#(REQUI-am . <br /> 1 ITY OF EVERETT BUSINESS LICENSE#(REQUIR ): <br /> PRIMARY CONTACT: 0 OWNER = CONTRACTOR 0 OTHER(Please Specify) .4%,®Afie•sitA Ir.— <br /> CONTACT NAME: CONTACT PHONE: 4,26,--' 9t V9,03 <br /> CONTACT EMAIL:/`'k�./...0 /0,a�SCd-i,/2rTy eol, <br /> BUILDING PERMIT APPLICATION <br /> Existing Use of Building: 61-0/L, Contract Price of Work:$ s5-0t, <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Building Type: ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: OCommercial ❑Industrial <br /> Type of Project: ❑New ❑Addition aRemodel ❑Repair CIT.!. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Use <br /> DESCRIPTION OF WORK:iit4477W/ 1VCit,rj,Qe, Alietzsv, so-sr-eft.), <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 List of Fixtures #of List of Fixtures #°f List of Fixtures #of 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 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 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 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 comply with the State Contractors Law 18.27 RCW and 296.200A WAC. <br /> City of Everett Official Use Only <br /> ^ Alf' <br /> l PE`-/`TD9 l35 <br /> Owner/ tho ized Agent Sig atureO D to (Revised 9/23/2016) <br />